Aims Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There are no data on long-term outcomes after aortic ViV. Our aim was to perform a large-scale assessment of long-term survival and reintervention after aortic ViV. Methods A total of 1006 aortic ViV procedures performed more than 5 years ago [mean age 77.7 ± 9.7 years; 58.8% male; and results median STS-PROM score 7.3% (4.2-12.0)] were included in the analysis. Patients were treated with Medtronic self-expandable valves (CoreValve/Evolut, Medtronic Inc., Minneapolis, MN, USA) (n = 523, 52.0%), Edwards balloon-expandable valves (EBEV, SAPIEN/SAPIEN XT/SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) (n = 435, 43.2%), and other devices (n = 48, 4.8%). Survival was lower at 8 years in patients with small-failed bioprostheses [internal diameter (ID) <_ 20 mm] compared with those with large-failed bioprostheses (ID > 20 mm) (33.2% vs. 40.5%, P = 0.01). Independent correlates for mortality included smaller-failed bioprosthetic valves [hazard ratio (HR) 1.07 (95% confidence interval (CI) 1.02-1.13)], age [HR 1.21 (95% CI 1.01-1.45)], and non-transfemoral access [HR 1.43 (95% CI 1.11-1.84)]. There were 40 reinterventions after ViV. Independent correlates for all-cause reintervention included pre-existing severe prosthesis-patient mismatch [subhazard ratio (SHR) 4.34 (95% CI 1.31-14.39)], device malposition [SHR 3.75 (95% CI 1.36-10.35)], EBEV [SHR 3.34 (95% CI 1.26-8.85)], and age [SHR 0.59 (95% CI 0.44-0.78)]. Conclusions The size of the original failed valve may influence long-term mortality, and the type of the transcatheter valve may influence the need for reintervention after aortic ViV.

Long-term outcomes after transcatheter aortic valve implantation in failed bioprosthetic valves

Simonato M.;Testa L.;Napodano M.;Petronio A. S.;
2020-01-01

Abstract

Aims Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There are no data on long-term outcomes after aortic ViV. Our aim was to perform a large-scale assessment of long-term survival and reintervention after aortic ViV. Methods A total of 1006 aortic ViV procedures performed more than 5 years ago [mean age 77.7 ± 9.7 years; 58.8% male; and results median STS-PROM score 7.3% (4.2-12.0)] were included in the analysis. Patients were treated with Medtronic self-expandable valves (CoreValve/Evolut, Medtronic Inc., Minneapolis, MN, USA) (n = 523, 52.0%), Edwards balloon-expandable valves (EBEV, SAPIEN/SAPIEN XT/SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) (n = 435, 43.2%), and other devices (n = 48, 4.8%). Survival was lower at 8 years in patients with small-failed bioprostheses [internal diameter (ID) <_ 20 mm] compared with those with large-failed bioprostheses (ID > 20 mm) (33.2% vs. 40.5%, P = 0.01). Independent correlates for mortality included smaller-failed bioprosthetic valves [hazard ratio (HR) 1.07 (95% confidence interval (CI) 1.02-1.13)], age [HR 1.21 (95% CI 1.01-1.45)], and non-transfemoral access [HR 1.43 (95% CI 1.11-1.84)]. There were 40 reinterventions after ViV. Independent correlates for all-cause reintervention included pre-existing severe prosthesis-patient mismatch [subhazard ratio (SHR) 4.34 (95% CI 1.31-14.39)], device malposition [SHR 3.75 (95% CI 1.36-10.35)], EBEV [SHR 3.34 (95% CI 1.26-8.85)], and age [SHR 0.59 (95% CI 0.44-0.78)]. Conclusions The size of the original failed valve may influence long-term mortality, and the type of the transcatheter valve may influence the need for reintervention after aortic ViV.
2020
Bleiziffer, S.; Simonato, M.; Webb, J. G.; Rodes-Cabau, J.; Pibarot, P.; Kornowski, R.; Windecker, S.; Erlebach, M.; Duncan, A.; Seiffert, M.; Unbehaun, A.; Frerker, C.; Conzelmann, L.; Wijeysundera, H.; Kim, W. -K.; Montorfano, M.; Latib, A.; Tchetche, D.; Allali, A.; Abdel-Wahab, M.; Orvin, K.; Stortecky, S.; Nissen, H.; Holzamer, A.; Urena, M.; Testa, L.; Agrifoglio, M.; Whisenant, B.; Sathananthan, J.; Napodano, M.; Landi, A.; Fiorina, C.; Zittermann, A.; Veulemans, V.; Sinning, J. -M.; Saia, F.; Brecker, S.; Presbitero, P.; de Backer, O.; Sondergaard, L.; Bruschi, G.; Franco, L. N.; Petronio, A. S.; Barbanti, M.; Cerillo, A.; Spargias, K.; Schofer, J.; Cohen, M.; Munoz-Garcia, A.; Finkelstein, A.; Adam, M.; Serra, V.; Teles, R. C.; Champagnac, D.; Iadanza, A.; Chodor, P.; Eggebrecht, H.; Welsh, R.; Caixeta, A.; Salizzoni, S.; Dager, A.; Auffret, V.; Cheema, A.; Ubben, T.; Ancona, M.; Rudolph, T.; Gummert, J.; Tseng, E.; Noble, S.; Bunc, M.; Roberts, D.; Kass, M.; Gupta, A.; Leon, M. B.; Dvir, D.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/1072688
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