Short- and Medium-Term Outcomes Comparison of Native- and Valve-in-Valve TAVI Procedures

Peter V Bartos; Balazs Molnar; Zoltan Herold; Gabor Dekany; Zsolt Piroth; Gergely Horvath; Abdelkrim Ahres; Christian M Heesch; Nikoletta R Czobor; Sai Satish; Tunde Pinter; Geza Fontos; Peter Andreka

doi:10.31083/j.rcm2409255

Short- and Medium-Term Outcomes Comparison of Native- and Valve-in-Valve TAVI Procedures

Rev Cardiovasc Med. 2023 Sep 18;24(9):255. doi: 10.31083/j.rcm2409255. eCollection 2023 Sep.

Authors

Peter V Bartos^{1

2}, Balazs Molnar², Zoltan Herold³, Gabor Dekany^{1

2}, Zsolt Piroth¹, Gergely Horvath¹, Abdelkrim Ahres^{1

2}, Christian M Heesch^{1

4}, Nikoletta R Czobor¹, Sai Satish⁵, Tunde Pinter¹, Geza Fontos¹, Peter Andreka¹

Affiliations

¹ Department of Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary.
² Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, 1085 Budapest, Hungary.
³ Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary.
⁴ Department of Interventional Cardiology, Florida Heart Clinic, Hallandale Beach, FL 33009, USA.
⁵ Department of Interventional Cardiology, Apollo Hospital, 600006 Chennai, India.

Abstract

Background: In high-risk patients with degenerated aortic bioprostheses, valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as a less invasive alternative to surgical valve replacement. To compare outcomes of ViV and native valve (NV) TAVI procedures.

Methods: 34 aortic ViV-TAVI performed between 2012 and 2022 using self-expanding valves, were included in this retrospective analysis. Propensity score matching (1:2 ratio, 19 criteria) was used to select a comparison NV-TAVI group from a database of 1206 TAVI procedures. Clinical and echocardiographic endpoints, short- and long-term all-cause mortality (ACM) and cardiovascular mortality (CVM) data were obtained. Subgroup analyses were completed according to the true internal diameter, dividing patients into a small ( $\leq$ 19 mm) valve group (SVG) and a large ( $>$ 19 mm) valve group (LVG).

Results: Clinical outcomes of ViV- and NV-TAVI were comparable, including device success [88.2% vs. 91.1%, p = 0.727], major adverse cardiovascular and cerebrovascular events [5.8% vs. 5.8%, p = 1.000], hemodialysis need [5.8% vs. 2.9%, p = 0.599], pacemaker need [2.9% vs. 11.7%, p = 0.265], major vascular complications [2.9% vs. 1.4%, p = 1.000], life-threatening or major bleeding [2.9% vs. 1.4%, p = 1.000] and in-hospital mortality [8.8% vs. 5.9%, p = 0.556]. There was a significant difference in the immediate post-intervention mean residual aortic valve gradient (MAVG) [14.6 $\pm$ 8.5 mm Hg vs. 6.4 $\pm$ 4.5 mm Hg, p $<$ 0.0001], which persisted at 1 year [p = 0.0002]. There were no differences in 12- or 30-month ACM [11.8% vs. 8.8%, p = 0.588; 23.5% vs. 27.9%, p = 0.948], and CVM [11.8% vs. 7.3%, p = 0.441; 23.5% vs. 16.2%, p = 0.239]. Lastly, there was no difference in CVM at 1 year and 30 months [11.1% vs. 12.5%, p = 0.889; 22.2% vs. 25.0%, p = 0.742].

Conclusions: Analyzing a limited group (n = 34) of ViV-TAVI procedures out of 1206 TAVIs done at a single institution, ViV-TAVI appeared to be an acceptable approach in patients not deemed appropriate candidates for redo valve replacement surgery. Clinical outcomes of ViV-TAVI were comparable to TAVI for native valve stenosis.

Keywords: aortic stenosis; residual mean aortic valve gradient; transcatheter aortic valve implantation; valve-in-valve transcatheter aortic valve implantation.