Valve-in-Valve with Self-Expanding Prosthesis: What Happens with Gradients at One Year?

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.

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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%).

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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.

Conclusion

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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