VARC-3 defined outcome of valve-in-valve transcatheter aortic valve implantation in stentless compared with stented aortic bioprostheses

Background Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is a viable alternative to redo surgery in selected patients with bioprosthetic valve dysfunction. Most ViV-TAVI procedures have been performed in stented bioprosthetic valves (ST); stentless bioprostheses (SL) lack fluor...

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Vydáno v:Clinical research in cardiology Ročník 114; číslo 3; s. 291 - 301
Hlavní autoři: Steul, Jean-Honoré, Abdel-Wahab, Mohamed, Stankowski, Tomasz, Haussig, Stephan, Woitek, Felix J., Gasior, Tomasz, Crusius, Lisa, Knorr, Luise, Müller, Felicitas V., Fritzsche, Dirk, Kiefer, Philipp, Kappert, Utz, Holzhey, David, Linke, Axel, Mangner, Norman
Médium: Journal Article
Jazyk:angličtina
Vydáno: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2025
Springer Nature B.V
Témata:
Aged
Aged, 80 and over
Aorta
Aortic valve
Aortic Valve - diagnostic imaging
Aortic Valve - surgery
Aortic Valve Stenosis - mortality
Aortic Valve Stenosis - surgery
Bioprosthesis
Cardiology
Comorbidity
Female
Fluoroscopy
Follow-Up Studies
Germany - epidemiology
Heart Valve Prosthesis
Heart valves
Humans
Implantation
Male
Medicine
Medicine & Public Health
Mortality
Original Paper
Prosthesis Design
Prosthesis Failure
Retrospective Studies
Risk Factors
Stents
Success
Time Factors
Transcatheter Aortic Valve Replacement - adverse effects
Transcatheter Aortic Valve Replacement - instrumentation
Transcatheter Aortic Valve Replacement - methods
Treatment Outcome
Germany
Valve-in-valve
Transcatheter aortic valve implantation
VARC-3
Stentless bioprosthesis
Stented bioprosthesis
ISSN:1861-0684, 1861-0692, 1861-0692
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Shrnutí:Background Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is a viable alternative to redo surgery in selected patients with bioprosthetic valve dysfunction. Most ViV-TAVI procedures have been performed in stented bioprosthetic valves (ST); stentless bioprostheses (SL) lack fluoroscopic markers and could be more challenging for ViV-TAVI. Data on more recent patients applying Valve Academic Research Consortium (VARC)-3 defined outcomes are scarce. We compared patient characteristics, procedural outcomes, and 5-year mortality of patients with SL versus ST aortic bioprosthetic valve failure undergoing ViV-TAVI. Methods Patients undergoing ViV-TAVI between 2007 and 2022 (52.5% of cases after 2015) at 3 German centers were included in this analysis. The co-primary outcome measures were technical success, device success, and early safety defined by VARC-3. Mortality was assessed up to 5 years. Results Overall, 43 (11.8%) SL and 313 (88.2%) ST ViV-TAVI were included. Patients were comparable with regard to age, sex, clinically relevant baseline comorbidities, and surgical risk. Technical success (SL: 83.7% versus ST: 79.9%, p  = 0.552), device success (SL: 67.4% versus ST: 54.3%, p  = 0.105), and early safety (SL: 74.4% versus ST: 66.5%, p  = 0.296) were comparable between groups. The 30-day mortality (SL: 7.0% versus ST: 2.6%, p  = 0.136) and 5-year mortality rates (SL: 23.3% versus ST: 24.6%, p  = 0.874) were not significantly different between groups. Conclusion SL and ST ViV-TAVI led to comparable short-term outcomes according to VARC-3- defined endpoints and similar mortality rates up to 5 years of follow-up. Graphical abstract VARC-3 defined technical success, device success, and early safety as well as 5-year all-cause mortality in patients undergoing valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) into stentless (SL) compared with stented (ST) failed aortic bioprostheses.
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ISSN:1861-0684
1861-0692
1861-0692
DOI:10.1007/s00392-023-02347-5