First evaluation of long-term outcomes after aortic valve-in-valve presented at PCR e-Course 2020

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Danny Dvir

Long-term clinical outcomes, including mortality, following an aortic valve-in-valve procedure may be affected by the size of the original degenerated bioprosthetic valve, according to findings from the Valve-in-Valve International Data (VIVID) Registry which were released at the PCR e-Course 2020 (25-27 June). The study, presented by Danny Dvir (Shaare Zedek Medical Centre, Israel and University of Washington Medical Center, Seattle, USA), also found that the need for reintervention after the procedure may be influenced by the type of transcatheter valve.

The retrospective multicentre data collection was performed, said Dvir, because long-term data after aortic valve-in-valve procedures are limited. “Our objective was to perform a large-scale assessment of long-term survival and reinterventions after transcatheter aortic valve-in-valve.”

The cases included were those that had been performed before December 2014 (that is, more than five years earlier), with small bioprosthetic valves defined as those with a true internal diameter of ≤20mm. A total of 1,006 aortic valve-in-valve procedures (mean age 77.7±9.7 years, 58.8% male, median Society of Thoracic Surgeons Predicted Risk of Mortality [STS-PROM] score 7.3%) were included in the analysis. Patients were treated with Medtronic self-expandable valves (CoreValve/Evolut, n=523, 52%), Edwards Lifesciences’ balloon-expandable valves (Sapien/Sapien XT/Sapien 3, n=435, 43.2%), and other devices (n=48, 4.8%).

Survival was lower at eight years in patients with small failed bioprostheses compared to those with large failed bioprostheses (internal diameter >20mm) (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 valve-in-valve. 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), Edwards Lifesciences’ balloon-expandable valves (SHR 3.34, 95% CI 1.26–8.85), and age (SHR 0.59, 95% CI 0.44–0.78).

Concluding, Dvir said: “Our analysis shows that 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 valve-in-valve. Hence, operator decisions during the original tissue valve implantation and/or during the valve-in-valve procedure may influence meaningful clinical outcomes.”


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