Transcatheter aortic valve‐in‐valve implantation within stentless landing zones: Procedural insights from a single‐center experience

Abstract

Background Valve‐in‐valve (VIV) transcatheter aortic valve implantation (TAVI) is a less invasive therapeutic option compared with redo surgical valve replacement for high‐risk patients. Relative to procedures within stented surgical valves, VIV‐TAVI within stentless valves is associated with a higher complication rate due to challenging underlying anatomy and absence of fluoroscopic landmarks. Aims We share a single‐center experience with VIV‐TAVI in stentless valves, discussing our procedural insights and associated outcomes. Methods Our institutional database was queried, and 25 patients who had undergone VIV‐TAVI within a stentless bioprosthesis, homograft, or valve‐sparing aortic root replacement between 2013 and 2022 were found. Outcome endpoints were based on the Valve Academic Research Consortium‐3 criteria. Results The mean age of the cohort was 69.5 ± 13.6 years. VIV implantation was performed within a homograft in 11 patients, a stentless bioprothesis in 10 patients, and a valve‐sparing aortic root replacement in 4 patients. Nineteen (76%) balloon‐expandable valves, 5 (20%) self‐expanding valves, and one mechanically‐expandable (4%) valve were implanted with 100% procedural success, with no instances of significant paravalvular leak, coronary occlusion, or device embolization. There was one (4%) in‐hospitality mortality after an emergency procedure; one (4%) patient experienced a transient ischemic attack; and two (8%) patients required permanent pacemaker implantation. The median length of hospital stay was 2 days. After a median follow‐up time of 16.5 months, valve function was acceptable in all patients with available data. Conclusion VIV‐TAVI within stentless valves can be safely performed with methodical procedural technique and can provide clinical benefit in patients at high reoperation risk.