.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 / S. Bleiziffer, M. Simonato, J.G. Webb, J.R. ́ s-Cabau, P. Pibarot, R. Kornowski, S. Windecker, M. Erlebach, A. Duncan, M. Seiffert, A. Unbehaun, C. Frerker, L. Conzelmann, H. Wijeysundera, W. Kim, M. Montorfano, A. Latib, D. Tchetche, A. Allali, M. Abdel-Wahab, K. Orvin, S. Stortecky, H. Nissen, A. Holzamer, M. Urena, L. Testa, M. Agrifoglio, B. Whisenant, J. Sathananthan, M. Napodano, A. Landi, C. Fiorina, A. Zittermann, V. Veulemans, J. Sinning, F. Saia, S. Brecker, P. Presbitero, O. De Backer, L. Søndergaard, G. Bruschi, L. Nombela Franco, A. Sonia Petronio, M. Barbanti, A. Cerillo, K. Spargias, J. Schofer, M. Cohen, A. Mu~noz-Garcia, A. Finkelstein, M. Adam, V. ̧ Serra, R. Campante Teles, D. Champagnac, A. Iadanza, P. Chodor, H. Eggebrecht, R. Welsh, A. Caixeta, S. Salizzoni, A. Dager, V. Auffret, A. Cheema, T. Ubben, M. Ancona, T. Rudolph, J. Gummert, E. Tseng, S. Noble, M. Bunc, D. Roberts, M. Kass, A. Gupta, M.B. Leon, D.D. (. - In: EUROPEAN HEART JOURNAL. - ISSN 1522-9645. - (2020). [Epub ahead of print] [10.1093/eurheartj/ehaa544]

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

M. Agrifoglio;
2020

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.
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
Settore MED/23 - Chirurgia Cardiaca
2020
27-giu-2020
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/745707
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