Transcatheter aortic valve implantation in failed bioprosthetic surgical valves - PubMed (original) (raw)

. 2014 Jul;312(2):162-70.

doi: 10.1001/jama.2014.7246.

John G Webb 1, Sabine Bleiziffer 2, Miralem Pasic 3, Ron Waksman 4, Susheel Kodali 5, Marco Barbanti 1, Azeem Latib 6, Ulrich Schaefer 7, Josep Rodés-Cabau 8, Hendrik Treede 9, Nicolo Piazza 10, David Hildick-Smith 11, Dominique Himbert 12, Thomas Walther 13, Christian Hengstenberg 14, Henrik Nissen 15, Raffi Bekeredjian 16, Patrizia Presbitero 17, Enrico Ferrari 18, Amit Segev 19, Arend de Weger 20, Stephan Windecker 21, Neil E Moat 22, Massimo Napodano 23, Manuel Wilbring 24, Alfredo G Cerillo 25, Stephen Brecker 26, Didier Tchetche 27, Thierry Lefèvre 28, Federico De Marco 29, Claudia Fiorina 30, Anna Sonia Petronio 31, Rui C Teles 32, Luca Testa 33, Jean-Claude Laborde 26, Martin B Leon 5, Ran Kornowski 34; Valve-in-Valve International Data Registry Investigators

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Transcatheter aortic valve implantation in failed bioprosthetic surgical valves

Danny Dvir et al. JAMA. 2014 Jul.

Free article

Abstract

Importance: Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it is expected that patients will increasingly present with degenerated bioprostheses in the next few years. Transcatheter aortic valve-in-valve implantation is a less invasive approach for patients with structural valve deterioration; however, a comprehensive evaluation of survival after the procedure has not yet been performed.

Objective: To determine the survival of patients after transcatheter valve-in-valve implantation inside failed surgical bioprosthetic valves.

Design, setting, and participants: Correlates for survival were evaluated using a multinational valve-in-valve registry that included 459 patients with degenerated bioprosthetic valves undergoing valve-in-valve implantation between 2007 and May 2013 in 55 centers (mean age, 77.6 [SD, 9.8] years; 56% men; median Society of Thoracic Surgeons mortality prediction score, 9.8% [interquartile range, 7.7%-16%]). Surgical valves were classified as small (≤21 mm; 29.7%), intermediate (>21 and <25 mm; 39.3%), and large (≥25 mm; 31%). Implanted devices included both balloon- and self-expandable valves.

Main outcomes and measures: Survival, stroke, and New York Heart Association functional class.

Results: Modes of bioprosthesis failure were stenosis (n = 181 [39.4%]), regurgitation (n = 139 [30.3%]), and combined (n = 139 [30.3%]). The stenosis group had a higher percentage of small valves (37% vs 20.9% and 26.6% in the regurgitation and combined groups, respectively; P = .005). Within 1 month following valve-in-valve implantation, 35 (7.6%) patients died, 8 (1.7%) had major stroke, and 313 (92.6%) of surviving patients had good functional status (New York Heart Association class I/II). The overall 1-year Kaplan-Meier survival rate was 83.2% (95% CI, 80.8%-84.7%; 62 death events; 228 survivors). Patients in the stenosis group had worse 1-year survival (76.6%; 95% CI, 68.9%-83.1%; 34 deaths; 86 survivors) in comparison with the regurgitation group (91.2%; 95% CI, 85.7%-96.7%; 10 deaths; 76 survivors) and the combined group (83.9%; 95% CI, 76.8%-91%; 18 deaths; 66 survivors) (P = .01). Similarly, patients with small valves had worse 1-year survival (74.8% [95% CI, 66.2%-83.4%]; 27 deaths; 57 survivors) vs with intermediate-sized valves (81.8%; 95% CI, 75.3%-88.3%; 26 deaths; 92 survivors) and with large valves (93.3%; 95% CI, 85.7%-96.7%; 7 deaths; 73 survivors) (P = .001). Factors associated with mortality within 1 year included having small surgical bioprosthesis (≤21 mm; hazard ratio, 2.04; 95% CI, 1.14-3.67; P = .02) and baseline stenosis (vs regurgitation; hazard ratio, 3.07; 95% CI, 1.33-7.08; P = .008).

Conclusions and relevance: In this registry of patients who underwent transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic valves, overall 1-year survival was 83.2%. Survival was lower among patients with small bioprostheses and those with predominant surgical valve stenosis.

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