The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Outcomes of Valve-In-Valve Transcatheter Aortic Valve Replacement in Patients with Failed Bioprosthetic Aortic Valves: Systematic Review and Meta-analysis of Observational Evidence

DOI: 10.4244/EIJ-D-19-00928

1. Division of Cardiology, University of Washington, Seattle, Washington, USA, UNnited States
2. Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio, United States
3. Massachusetts General Hospital, Cardiology, Boston, United States
4. Department of Medicine, University of Florida, Gainesville, Florida, United States
5. Division of Cardiology, University of Florida, Gainesville, Florida, United States
6. Escola Paulista de Medicina - Universidade Federal de São Paulo, Brazil

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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.

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