Transcatheter aortic valve-in-valve implantation for failed surgical bioprostheses: Results from the Polish Transcatheter Aortic Valve-in-Valve Implantation (ViV-TAVI) Registry

Abstract

Introduction Transcatheter aortic valve-in-valve implantation (ViV-TAVI) has emerged as an alternative to redo surgery in patients with failed surgical aortic bioprosthesis. Objectives We evaluated the safety and efficacy of ViV-TAVI in Polish patients after surgical aortic valve replacement. Patient s and methods This was a nationwide multicenter registry of ViV-TAVI procedures. Data were collected using an online form, and the clinical follow-up lasted 1 year. Result s From 2008 to 2020, 130 ViV-TAVI procedures were performed (1.9% of all transcatheter aortic valve implantation [TAVI] cases). A considerable increase in ViV-TAVI procedures since 2018 has been observed (n = 59, 45% of ViV-TAVI cases). Hancock II, Freestyle, and homograft were the most frequently treated bioprostheses. The self-expanding supra-annular Corevalve / Evolut valve was used in 76% of cases. In 21% of cases, the mean postprocedural pressure gradient (PG) exceeded 20 mm Hg. All-cause mortality at 1 year was 10.8%. Aortic valve stenosis was associated with a higher mean PG than aortic valve regurgitation or mixed disease (P = 0.004). Supra-annular transcatheter aortic valves were associated with lower mean PGs than intra-annular valves (P = 0.004). Second-generation devices were associated with shorter procedure time (120 min vs 135 min, P = 0.04), less frequent need for additional TAVI (2% vs 10%, P = 0.04), and lower 1-year cardiovascular mortality (95% vs 82.8%, P = 0.03) than first-generation valves. Conclusions Transcatheter treatment of failed bioprostheses is increasingly common, with the best hemodynamic effect shown for supra-annular valves. The introduction of second-generation valves has improved procedural and clinical outcomes.