AIMS: To evaluate the evidence regarding the rates of procedural success and incidence of adverse outcomes following valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) in patients with failed bioprosthetic aortic valves. METHODS AND RESULTS: A systematic search of major electronic databases was conducted, for studies relevant to patients with failed bioprosthetic aortic valves undergoing VIV-TAVR. The primary outcome was procedural success. A total of 5,553 patients from 24 studies were included. The mean Society of Thoracic Surgery (STS) score was 7.84 +/- 5.14. The procedural success rate was high (97 %, 95% confidence interval [CI]: 94 - 98%). At 30-day, of all-cause mortality was 5% (95% CI: 3 - 6%), stroke 2% (95% CI: 1 - 2%), myocardial infarction 1% (95% CI: 1 - 2%), permanent pacemaker placement 6% (95% CI: 5 - 8%), and aortic regurgitation 7% (95% CI: 5 - 10%) at 30-days. At 1-year, incidence of all-cause mortality was 12% (95% CI: 10 - 14%), stroke 3% (95% CI: 2 - 4%), myocardial infarction 1% (95% CI: 0 - 2%), and permanent pacemaker placement 7% (95% CI: 5 - 11%). At three years, the incidence of all-cause mortality was 29% (95% CI: 25 - 34%) and stroke 6% (95% CI: 5 - 9%). CONCLUSIONS: VIV-TAVR appears to be associated with high procedural success rates and low adverse outcomes during the short and mid-term follow-up period.
AIMS: To evaluate the evidence regarding the rates of procedural success and incidence of adverse outcomes following valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) in patients with failed bioprosthetic aortic valves. METHODS AND RESULTS: A systematic search of major electronic databases was conducted, for studies relevant to patients with failed bioprosthetic aortic valves undergoing VIV-TAVR. The primary outcome was procedural success. A total of 5,553 patients from 24 studies were included. The mean Society of Thoracic Surgery (STS) score was 7.84 +/- 5.14. The procedural success rate was high (97 %, 95% confidence interval [CI]: 94 - 98%). At 30-day, of all-cause mortality was 5% (95% CI: 3 - 6%), stroke 2% (95% CI: 1 - 2%), myocardial infarction 1% (95% CI: 1 - 2%), permanent pacemaker placement 6% (95% CI: 5 - 8%), and aortic regurgitation 7% (95% CI: 5 - 10%) at 30-days. At 1-year, incidence of all-cause mortality was 12% (95% CI: 10 - 14%), stroke 3% (95% CI: 2 - 4%), myocardial infarction 1% (95% CI: 0 - 2%), and permanent pacemaker placement 7% (95% CI: 5 - 11%). At three years, the incidence of all-cause mortality was 29% (95% CI: 25 - 34%) and stroke 6% (95% CI: 5 - 9%). CONCLUSIONS: VIV-TAVR appears to be associated with high procedural success rates and low adverse outcomes during the short and mid-term follow-up period.