Interventions for valvular disease and heart failure

Transcatheter aortic valve-in-valve implantation in degenerative rapid deployment bioprostheses

EuroIntervention 2019;15:37-43. DOI: 10.4244/EIJ-D-18-00752

Uri Landes
Uri Landes1,2, MD; Danny Dvir3, MD; Wolfgang Schoels4, MD; Christopher Tron5, MD; Stephan Ensminger6, MD; Matheus Simonato3, MD; Ulrich Schäfer7, MD; Matjaz Bunc8, MD; Gabriel S. Aldea9, MD; Alfredo Cerillo10, MD; Stephan Windecker11, MD; Antonio Marzocchi12, MD; Martin Andreas13, MD; Nicolas Amabile14, MD; John Webb3, MD; Ran Kornowski1,2, MD
1. Rabin Medical Center, Petah Tikva, Israel; 2. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel; 3. St. Paul’s Hospital, Vancouver, BC, Canada; 4. Klinikum Duisburg, Duisburg, Germany; 5. Charles-Nicolle Hospital, Rouen, France; 6. Diabeteszentrum Bad Oeynhausen, Bad Oeynhausen, Germany; 7. Structural Heart Disease Program, Hamburg, Germany; 8. University Medical Centre Ljubljana, Ljubljana, Slovenia; 9. University of Washington Medical Center, Seattle, WA, USA; 10. G. Pasquinucci Hospital, Massa, Italy; 11. Bern University Hospital, Bern, Switzerland; 12. Policlinico S. Orsola Malpighi, Bologna, Italy; 13. Medical University of Vienna, Vienna, Austria; 14. Institut Mutualiste Montsouris, Paris, France


Aims: The aim of this study was to evaluate transcatheter aortic valve-in-valve (ViV) implantation performance in rapid deployment (ViVr) vs. conventional (ViVc) surgical heart valves.

Methods and results: A multicentre registry was developed as part of the VIVID international registry. A total of 30 ViVr patients (Perceval, n=24, ATS 3f Enable™, n=5, and the INTUITY, n=1) were evaluated and compared with 2,288 ViVc patients. Propensity score (PS) matching was performed to adjust further for bias. Compared with ViVc, ViVr patients presented twice as early after surgical heart valve (SHV) implantation (55.2±36.1 vs. 118.4±57.7 months, p<0.001), were more commonly female (82.8% vs. 41.3%, p<0.001), and had shorter body stature and reduced body weight (p<0.05 for both) prior to PS. Implantation was successful in all ViVr cases and, compared with ViVc, was associated with equally favourable haemodynamic outcomes (mean gradient: 14.6±8.3 vs. 16.2±8.9 mmHg, p=0.356; regurgitation ≥mild: 3.7% vs. 5.2%, p=0.793). Periprocedural complication rates were similar and low in both groups. There was no coronary obstruction event in any ViVr case; one patient (3.6%) died during one year of follow-up.

Conclusions: ViVr appears effective, safe and associated with favourable haemodynamic outcome.

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