Outcomes Following Transcatheter Aortic Valve Replacement for Degenerative Stentless Versus Stented Bioprostheses

Alison Duncan, Neil Moat, Matheus Simonato, Arend de Weger, Jorg Kempfert, Holger Eggebrecht, Antony Walton, Farrel Hellig, Ran Kornowski, Konstantinos Spargias, Oscar Mendiz, Raj Makkar, Mayra Guerrero, Charanjit Rihal, Isaac George, Creighton Don, Alessandro Iadanza, Vinayak Bapat, Robert Welsh, Harindra C. WijeysunderaDavid Wood, Janarthanan Sathananthan, Haim Danenberg, Francesco Maisano, Santiago Garcia, Sameer Gafoor, Luis Nombela-Franco, Javier Cobiella, Danny Dvir

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Objectives: A large comprehensive analysis of transcatheter aortic valve replacement (TAVR) was performed for failed stentless bioprostheses. Background: Valve-in-valve (ViV) transcatheter aortic replacement (TAVR) is an alternative to redo surgery for patients with a failing aortic bioprosthesis. Methods: Unadjusted outcome data were collected from the VIVID (Valve-in-Valve International Data) registry between 2007 and 2016 from a total of 1,598 aortic ViV procedures (291 stentless, 1,307 stented bioprostheses). Results: Bioprosthetic failure was secondary to aortic regurgitation in 56% of stentless and 20% stented devices (p < 0.001). ViV-TAVR access was transfemoral in 71.1% stentless and 74.2% stented ViV-TAVR. Self-expanding devices were more frequently used in stentless ViV-TAVR (56.0% vs. 39.9%; p = 0.05), but there was no difference between balloon-expanding and self-expanding TAVR devices for stented ViV-TAVR (48.6% vs. 45.1%). The degree of oversizing for all mechanisms of bioprosthesis failure was 9 ± 10% for stentless ViV-TAVR vs. 6 ± 9% for stented ViV-TAVR (and 8 ± 10% for stentless ViV-TAVR vs. 3 ± 9% for stented ViV-TAVR in patients with predominant aortic regurgitation; both p < 0.001). Initial device malposition (10.3% vs. 6.2%; p = 0.014), second transcatheter device (7.9% vs. 3.4%), coronary obstruction (6.0% vs. 1.5%), and paravalvular leak occurred more frequently in stentless ViV-TAVR (all p < 0.001). Hospital stay duration (median 7 days) was no different, and 30-day (6.6% vs. 4.4%; p = 0.12) and 1-year mortality year (15.8% vs. 12.6%; p = 0.15) were numerically higher, but not statistically different, after stentless ViV-TAVR. Conclusions: Stentless ViV-TAVR is associated with greater periprocedural complications (initial device malposition, second transcatheter device, coronary obstruction, paravalvular leak), but no difference in 30-day and 1-year outcome.

Original languageEnglish (US)
Pages (from-to)1256-1263
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume12
Issue number13
DOIs
StatePublished - Jul 8 2019

Keywords

  • stented bioprostheses
  • stentless bioprostheses
  • transcatheter aortic valve replacement
  • valve-in-valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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