Premium
Severe structural deterioration of small aortic bioprostheses treated with valve‐in‐valve transcatheter aortic valve implantation
Author(s) -
Stankowski Tomasz,
AboulHassan Sleiman Sebastian,
SeifiZinab Farzaneh,
Herwig Volker,
Kubikova Miroslava,
Harnath Axel,
Fritzsche Dirk,
Perek Bartłomiej
Publication year - 2019
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.13976
Subject(s) - medicine , cardiology , ventricle , perforation , aortic valve , mortality rate , surgery , materials science , punching , metallurgy
Objectives The aim of this study was to evaluate outcomes of valve‐in‐valve transcatheter aortic valve implantation (VIV‐TAVI) in patients with degenerated small bioprostheses. Methods Outcomes of consecutive 27 high‐risk patients (logistic EuroSCORE 35.5 ± 18.5%) with a mean age of 81.0 ± 5.9 years who underwent VIV‐TAVI for degenerated small bioprostheses (19 mm‐11.1%; 20 mm‐11.1%; 21 mm‐77.8%) were analyzed. Medtronic CoreValve ( n = 11) or CoreValve Evolut‐R prostheses ( n = 16) were implanted. Follow‐up was 3.2 ± 2.0 years. Results Early mortality was 11.1%. One patient died intraoperatively due to left ventricle perforation, two others during the in‐hospital period as a result of sudden cardiac death and pulmonary embolism. VIV‐TAVI was completed in 26 cases (96.3%—success rate). Two patients required pacemaker implantation. Acute kidney injury occurred in two other patients. At discharge, mean transvalvular gradient was 19.2 ± 9.5 mmHg and in 25.9% of patients mean gradient exceeded 20 mmHg. Overall mortality was 25.9% and mortality from cardiac or unknown causes at 18.5%. Ninety percent of survivors were in New York Heart Association (NYHA) class I or II. Conclusions Transfemoral VIV‐TAVI in patients with small, degenerated bioprostheses appears to be a promising alternative to surgery. Although the vast majority of patients have significant improvement in their NYHA class, the rate of persistent, residual gradients is relatively high and will need to be followed closely with serial echocardiograms.