Degenerated surgical bioprostheses can be safely treated with CoreValve or CoreValve Evolut using the valve-in-valve procedure. Excellent 1-year clinical and hemodynamic outcomes were achieved in a non-selected regular population, i.e., “real-world” patients.
The VIVA (Valve in Valve) registry, conducted at 23 sites, was a prospective study designed to systematically collect data from patients with degenerated surgical prostheses who underwent transcatheter aortic valve replacement.
Researchers enrolled a total of 202 patients with degenerated surgical prostheses who were eligible for elective treatment with CoreValve or CoreValve Evolut R.
Mean patient age was 79.9 years old and the risk according to the Society of Thoracic Surgeons score was 6.6%.
Although 41.8% of patients had ≤21-mm surgical bioprostheses, valve hemodynamic parameters markedly improved from baseline (mean baseline valve gradient 35.0 ± 16.3 mmHg vs. 17.5 ± 8.6 mmHg at discharge). At 1 year, aortic regurgitation greater than mild was barely 1.1%.
Clinical events at 30 days demonstrated low mortality (2.5%), no disabling strokes, a 0.5% rate of acute kidney injury, and an 8% rate of permanent pacemaker implantation.
At 1 year, the mortality rate remained low (8.8%), with only 1 disabling stroke during that period (0.6%).
About 2.5% of patients (n = 5) experienced coronary artery occlusion as complication (one of the most feared for valve-in-valve); 3 took place during release, 1 immediately after the procedure, and only 1 several months later.
Surgically-implanted valves with bioprosthetic degeneration can be safely treated with the self-expanding device with more evidence in the market, which has excellent 1-year clinical and hemodynamic outcomes in this real-world non-selected population.
Orginal Title: TAVR for Failed Surgical Aortic Bioprostheses Using aSelf-Expanding Device 1-Year Results From the Prospective VIVA Postmarket Study.
Reference: Didier Tchétché et al.
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