Abstract Aims Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There are no data on long-term outcomes after aortic ViV. Our aim was to perform a large-scale assessment of long-term survival and reintervention after aortic ViV. Methods and results A total of 1006 aortic ViV procedures performed more than 5 years ago [mean age 77.7 ± 9.7 years; 58.8% male; median STS-PROM score 7.3% (4.2–12.0)] were included in the analysis. Patients were treated with Medtronic self-expandable valves (CoreValve/Evolut, Medtronic Inc., Minneapolis, MN, USA) (n = 523, 52.0%), Edwards balloon-expandable valves (EBEV, SAPIEN/SAPIEN XT/SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) (n = 435, 43.2%), and other devices (n = 48, 4.8%). Survival was lower at 8 years in patients with small-failed bioprostheses [internal diameter (ID) ≤ 20 mm] compared with those with large-failed bioprostheses (ID > 20 mm) (33.2% vs. 40.5%, P = 0.01). Independent correlates for mortality included smaller-failed bioprosthetic valves [hazard ratio (HR) 1.07 (95% confidence interval (CI) 1.02–1.13)], age [HR 1.21 (95% CI 1.01–1.45)], and non-transfemoral access [HR 1.43 (95% CI 1.11–1.84)]. There were 40 reinterventions after ViV. Independent correlates for all-cause reintervention included pre-existing severe prosthesis–patient mismatch [subhazard ratio (SHR) 4.34 (95% CI 1.31–14.39)], device malposition [SHR 3.75 (95% CI 1.36–10.35)], EBEV [SHR 3.34 (95% CI 1.26–8.85)], and age [SHR 0.59 (95% CI 0.44–0.78)]. Conclusions The size of the original failed valve may influence long-term mortality, and the type of the transcatheter valve may influence the need for reintervention after aortic ViV.

Long-term outcomes after transcatheter aortic valve implantation in failed bioprosthetic valves / Bleiziffer, Sabine; Simonato, Matheus; Webb John, G; Rodés-Cabau, Josep; Pibarot, Philippe; Kornowski, Ran; Windecker, Stephan; Erlebach, Magdalena; Duncan, Alison; Seiffert, Moritz; Unbehaun, Axel; Frerker, Christian; Conzelmann, Lars; Wijeysundera, Harindra; Kim, Won-Keun; Montorfano, M; Latib, Azeem; Tchetche, Didier; Allali, Abdelhakim; Abdel-Wahab, Mohamed; Orvin, Katia; Stortecky, Stefan; Nissen, Henrik; Holzamer, Andreas; Urena, Marina; Testa, Luca; Agrifoglio, Marco; Whisenant, Brian; Sathananthan, Janarthanan; Napodano, Massimo; Landi, Antonio; Fiorina, Claudia; Zittermann, Armin; Veulemans, Verena; Sinning, Jan-Malte; Saia, Francesco; Brecker, Stephen; Presbitero, Patrizia; De Backer, Ole; Søndergaard, Lars; Bruschi, Giuseppe; Franco Luis, Nombela; Petronio Anna, Sonia; Barbanti, Marco; Cerillo, Alfredo; Spargias, Konstantinos; Schofer, Joachim; Cohen, Mauricio; Muñoz-Garcia, Antonio; Finkelstein, Ariel; Adam, Matti; Serra, Vicenç; Teles Rui, Campante; Champagnac, Didier; Iadanza, Alessandro; Chodor, Piotr; Eggebrecht, Holger; Welsh, Robert; Caixeta, Adriano; Salizzoni, Stefano; Dager, Antonio; Auffret, Vincent; Cheema, Asim; Ubben, Timm; Ancona, Marco; Rudolph, Tanja; Gummert, Jan; Tseng, Elaine; Noble, Stephane; Bunc, Matjaz; Roberts, David; Kass, Malek; Gupta, Anuj; Leon Martin, B; Dvir, Danny. - In: EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES (ONLINE). - ISSN 2058-1742. - (In corso di stampa). [10.1093/eurheartj/ehaa544]

Long-term outcomes after transcatheter aortic valve implantation in failed bioprosthetic valves

Montorfano M;
In corso di stampa

Abstract

Abstract Aims Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There are no data on long-term outcomes after aortic ViV. Our aim was to perform a large-scale assessment of long-term survival and reintervention after aortic ViV. Methods and results A total of 1006 aortic ViV procedures performed more than 5 years ago [mean age 77.7 ± 9.7 years; 58.8% male; median STS-PROM score 7.3% (4.2–12.0)] were included in the analysis. Patients were treated with Medtronic self-expandable valves (CoreValve/Evolut, Medtronic Inc., Minneapolis, MN, USA) (n = 523, 52.0%), Edwards balloon-expandable valves (EBEV, SAPIEN/SAPIEN XT/SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) (n = 435, 43.2%), and other devices (n = 48, 4.8%). Survival was lower at 8 years in patients with small-failed bioprostheses [internal diameter (ID) ≤ 20 mm] compared with those with large-failed bioprostheses (ID > 20 mm) (33.2% vs. 40.5%, P = 0.01). Independent correlates for mortality included smaller-failed bioprosthetic valves [hazard ratio (HR) 1.07 (95% confidence interval (CI) 1.02–1.13)], age [HR 1.21 (95% CI 1.01–1.45)], and non-transfemoral access [HR 1.43 (95% CI 1.11–1.84)]. There were 40 reinterventions after ViV. Independent correlates for all-cause reintervention included pre-existing severe prosthesis–patient mismatch [subhazard ratio (SHR) 4.34 (95% CI 1.31–14.39)], device malposition [SHR 3.75 (95% CI 1.36–10.35)], EBEV [SHR 3.34 (95% CI 1.26–8.85)], and age [SHR 0.59 (95% CI 0.44–0.78)]. Conclusions The size of the original failed valve may influence long-term mortality, and the type of the transcatheter valve may influence the need for reintervention after aortic ViV.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11768/144668
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