Zenon Huczek1, Kajetan Grodecki1, Piotr Scisło1, Krzysztof Wilczek2, Dariusz Jagielak3, Wojciech Fil4, Piotr Kubler5, Piotr Olszówka6, Maciej Dąbrowski7, Marek Frank8, Marek Grygier9, Michał Kidawa10, Radosław Wilimski11, Katarzyna Żelazowska12, Adam Witkowski7, Janusz Kochman1, Marian Zembala13, Grzegorz Opolski1, Danny Dvir14, Wojciech Wojakowski12. 1. 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. 2. Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Disease, Zabrze, Poland. 3. Department of Cardiac Surgery, Medical University of Gdansk, Gdansk, Poland. 4. Polish-American Heart Clinic, Bielsko-Biala, Poland. 5. Department of Cardiology, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland. 6. Department of Cardiac Surgery, District Hospital 2, Rzeszow, Poland. 7. Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. 8. Department of Cardiac Surgery, Medical University of Bialystok, Bialystok, Poland. 9. Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland. 10. Department of Intensive Cardiac Care, Medical University of Lodz, Lodz, Poland. 11. Department of Cardiac Surgery, Medical University of Warsaw, Warsaw, Poland. 12. 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland. 13. Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Disease, Zabrze, Poland. 14. Division of Cardiology, University of Washington Medical Center, Seattle, Washington.
Abstract
OBJECTIVE: To compare the safety and efficacy of transcathether aortic valve-in-valve implantation (ViV-TAVI) in degenerated stentless bioprostheses with failed stented valves and degenerated native aortic valves. INTRODUCTION: Little is known about ViV-TAVI in degenerated stentless valves. METHODS: Out of 45 ViV-TAVI procedures reported in the POL-TAVI registry, 20 failed stentless valves were compared with 25 stented prostheses and propensity-matched with 45 native TAVI cases. The mean follow-up was 633 (95% confidence interval [CI], 471-795) days and Valve Academic Research Consortium-2 (VARC-2) definitions were applied. RESULTS: Patients with degenerated stentless valves were younger (65.6, CI 58-73.1 years vs 75.6, CI 72.2-78 [stented] vs 80.1, CI 78.7-81.6 y. [native], P < 0.001). Implantation was required later after surgery (11.5, CI 8-14.9 years) in the stentless cohort as compared with the stented one (6.2, CI 4.7-7.6 years, P = 0.006). ViV-TAVI in the stentless group was also associated with larger amount of contrast (211, CI 157-266 mL vs 135, CI 104-167 mL [stented] vs 132 (119-145) mL [native], P = 0.022). Using VARC-2 composite endpoints, ViV-TAVI in stentless prostheses was characterized by a lower device success (50% vs 76% in stented vs 88.9% in native TAVI, P < 0.001), but comparable early safety up to 30 days (73.7% vs 84% vs 81.8%, respectively, log-rank P = 0.667) and long-term clinical efficacy beyond 30 days (72.2% vs 72% vs 73.8%, respectively, log-rank P = 0.963). CONCLUSIONS: Despite technical challenges and a lower device success, ViV-TAVI in stentless aortic bioprostheses achieves similar safety, efficacy, and functional improvement as in stented or degenerated native valves.
OBJECTIVE: To compare the safety and efficacy of transcathether aortic valve-in-valve implantation (ViV-TAVI) in degenerated stentless bioprostheses with failed stented valves and degenerated native aortic valves. INTRODUCTION: Little is known about ViV-TAVI in degenerated stentless valves. METHODS: Out of 45 ViV-TAVI procedures reported in the POL-TAVI registry, 20 failed stentless valves were compared with 25 stented prostheses and propensity-matched with 45 native TAVI cases. The mean follow-up was 633 (95% confidence interval [CI], 471-795) days and Valve Academic Research Consortium-2 (VARC-2) definitions were applied. RESULTS:Patients with degenerated stentless valves were younger (65.6, CI 58-73.1 years vs 75.6, CI 72.2-78 [stented] vs 80.1, CI 78.7-81.6 y. [native], P < 0.001). Implantation was required later after surgery (11.5, CI 8-14.9 years) in the stentless cohort as compared with the stented one (6.2, CI 4.7-7.6 years, P = 0.006). ViV-TAVI in the stentless group was also associated with larger amount of contrast (211, CI 157-266 mL vs 135, CI 104-167 mL [stented] vs 132 (119-145) mL [native], P = 0.022). Using VARC-2 composite endpoints, ViV-TAVI in stentless prostheses was characterized by a lower device success (50% vs 76% in stented vs 88.9% in native TAVI, P < 0.001), but comparable early safety up to 30 days (73.7% vs 84% vs 81.8%, respectively, log-rank P = 0.667) and long-term clinical efficacy beyond 30 days (72.2% vs 72% vs 73.8%, respectively, log-rank P = 0.963). CONCLUSIONS: Despite technical challenges and a lower device success, ViV-TAVI in stentless aortic bioprostheses achieves similar safety, efficacy, and functional improvement as in stented or degenerated native valves.
Authors: R Yazan Kherallah; Srikanth Koneru; Zvonimir Krajcer; Ourania Preventza; Kathryn G Dougherty; Melissa L McCormack; Briana T Costello; Stephanie Coulter; Neil E Strickman; Juan Carlos Plana Gomez; Ali Mortazavi; Jose G Díez; James J Livesay; Joseph S Coselli; Guilherme V Silva Journal: Ann Cardiothorac Surg Date: 2021-09
Authors: Sascha Macherey; Max Meertens; Victor Mauri; Christian Frerker; Matti Adam; Stephan Baldus; Tobias Schmidt Journal: J Am Heart Assoc Date: 2021-03-08 Impact factor: 5.501