P913What can we expect after valve-in-valve procedures in failed transcatheter aortic valves?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Goppel ◽  
H Ruge ◽  
M Erlebach ◽  
O Deutsch ◽  
J Ziegelmueller ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
P Value ◽  
Aortic Valve Area ◽  
Surgical Aortic Valve Replacement ◽  
Valve In Valve ◽  
Sts Score ◽  
Valve Area

Abstract Background/Purpose With the growing use of transcatheter aortic valve replacement (TAVR), we need to determine if repeat TAVR (TAV-in-TAV) is comparable or even superior to surgical aortic valve replacement followed by TAVR (TAV-in-SAV). Although TAV-in-SAV procedures were shown to provide an almost complete sealing of paravalvular leakage at the expense of elevated gradients, data for TAV-in-TAV are lacking. Hence, we compared echocardiographic and clinical outcome in all TAV-in-TAV and TAV-in-SAV procedures in our institution between Oct. 2007 and July 2017. Methods 130 consecutive valve-in-valve patients out of 2351 TAVR-patients were identified. 24 patients were excluded. Patient data were analysed from our prospectively collected, institutional database. 93% underwent routine out-patient follow-up at 12 months. Results 75 TAV-in-SAV (75±8 years, male 60%; STS score 5.2±4.0%) and 31 TAV-in-TAV patients (78±8 years, male 65%; STS score 4.6±2.8%) formed the final study population. The type of TAV was similarly distributed in both groups (self-/balloon-expandable valves [%] 57/43 vs. 61/39) with transfemoral being the most frequent access site (68% vs. 87%). The mode of prosthesis failure was mainly stenosis in the TAV-in-SAV group (77%), whereas it was mainly intraoperative paravalvular regurgitation (90%) in the TAV-in-TAV group. 10% TAV-in-TAV patients (78±10 years, 33% male, STS score 5.1±1.5%) underwent redo-TAVR for prosthesis-degeneration after a mean time of 2614±862 days. The TAV-in-TAV group (90% single session vs. 10% staged: mean gradient 10±4 mmHg vs. 15±3 mmHg, p=0.096; aortic valve area 1.62±0.36 cm2 vs. 1.45±0.18 cm2, p=0.240) showed lower gradients and larger aortic valve areas (Table 1). No major intraprocedural complications occurred in either group. 30-day mortality was 0%. Table 1 75 TAV-in-SAV discharge 31 TAV-in-TAV discharge p-value 69 TAV-in-SAV 12mFU 30 TAV-in-TAV 12mFU p-value AVA (cm2) * 1.18±0.32 1.61±0.35 <0.001† 1.21±0.36 1.63±0.43 <0.001† Peak Gradient (mmHg) 33±14 23±8 <0.001† 31±14 21±8 <0.001† Mean Gradient (mmHg) 19±8 12±5 <0.001† 18±9 11±4 <0.001† AR (0–3)** 0.4±0.5 0.8±0.7 0.003† 0.4±0.5 0.8±0.6 0.001† LV ejection fraction (%) 49±12 49±16 0.970 54±12 50±10 0.081 *AVA = Aortic valve area; **AR = Aortic regurgitation. 0 = none, 1 = mild, 2 = moderate, 3 = severe. †p<0,05 significant. Conclusion Indications for TAV-in-TAV differ from those for TAV-in-SAV. TAV-in-TAV results in significantly lower gradients and larger aortic valve areas with no relevant aortic regurgitation. Accordingly, failed TAV valves may be treated with TAV-in-TAV in the future.

scholarly journals Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo Surgical Aortic Valve Replacement

2021 ◽  
Vol 14 (2) ◽  
pp. 211-220 ◽  
Author(s):  
Michel Pompeu B.O. Sá ◽  
Jef Van den Eynde ◽  
Matheus Simonato ◽  
Luiz Rafael P. Cavalcanti ◽  
Ilias P. Doulamis ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Valve In Valve

Abstract 12809: Pre-Procedural Aortic Valve Area Predicts Degree of Thrombocytopenia Following Trans-Catheter Aortic Valve Implantation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Elizabeth Retzer ◽  
Corey Tabit ◽  
Jonathan Paul ◽  
Sandeep Nathan ◽  
Janet Friant ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Antiplatelet Therapy ◽  
Pearson Correlation ◽  
P Value ◽  
Aortic Valve Area ◽  
Surgical Aortic Valve Replacement ◽  
Percutaneous Balloon ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
Valve Area

Introduction: Thrombocytopenia (TP) has been described following percutaneous balloon aortic valvuloplasty (BAV) and surgical aortic valve replacement (SAVR), but only recently noted following trans-catheter aortic valve implantation (TAVI). While transient, the TP may be severe leading to increased bleeding. Methods: We conducted a retrospective analysis of all patients undergoing TAVI with either a 23mm or 26mm Edwards Sapien valve (Edward Lifesciences, Irvine, California) at our institution.. The effect of multiple independent variables on % platelet change after TAVI were analyzed using paired and unpaired T-tests, two-way ANOVA, and Chi-square tests as appropriate. Platelet % change was correlated with aortic valve area using Pearson correlation. A p-value of <0.05 was considered statistically significant. Results: A total of 33 patients (54.5% male, median age 79.3, mean valve area 0.76 cm2) were included in this analysis. The degree of aortic valve stenosis significantly correlated with post-procedural TP severity (Figure 1). The degree of TP post TAVI was found to be significantly lower in those patients who received BAV prior to their TAVI procedure (p < 0.01). Conclusions: Post-TAVI TP correlates with the degree of pre-procedure aortic stenosis. Given the need for peri-procedural anticoagulation and post-procedural dual antiplatelet therapy, this finding can help identify patients at risk for symptomatic TP and may help guide post procedure antiplatelet therapy. Further studies are needed to elucidate the underlying mechanism.

Abstract 15174: Failing Aortic Tissue Valves in Patients at High Surgical Risk: Comparison of Outcomes After Transcatheter Aortic Valve-in-valve Procedures and Redo Surgical Aortic Valve Replacement

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Miriam Silaschi ◽  
Olaf Wendler ◽  
Liesa Castro ◽  
Moritz Seiffert ◽  
Edith Lubos ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Pacemaker Implantation ◽  
Pressure Gradients ◽  
Surgical Aortic Valve Replacement ◽  
Surgical Risk ◽  
Transcatheter Aortic Valve ◽  
High Surgical Risk ◽  
Valve In Valve

Objectives: Transcatheter aortic valve-in-valve implantation (ViV) is an innovative treatment for failed tissue valves (TV) in patients at high surgical risk. However, direct comparative data with standard repeat surgical aortic valve replacement (RE-SAVR) is scarce. We aimed to compare outcomes after ViV to conventional RE-SAVR in two European centers with established interventional programs. Methods: Retrospectively we explored in-hospital databases for patients ≥60 years, treated for degenerated TV. Patients with endocarditis and combined procedures were excluded. Primary endpoints were adjudicated according to VARC-2 criteria. Results: Between 2002 and 2015, 130 patients were treated for isolated failure of aortic TV’s (ViV: n=71, RE-SAVR: n=59). In ViV, Edwards Sapien valve (ESV) was most frequently used (n=36) but implanted into larger TV’s (CoreValve TV size: 22.2±1.3mm vs. ESV TV size: 24.1±2.0mm, p<0.01). Both age and logistic EuroSCORE I were higher in ViV compared to RE-SAVR (78.6±7.5 vs. 72.9±6.5 ys, p<0.01; 25.1±18.9 vs. 16.8±9.4%, p<0.01). Thirty-day mortality was not significantly different with 4.2% (3/71) after ViV vs. 5.1% (3/59) post RE-SAVR (p=1.0). Device success was achieved in 54.9% (n=39) in ViV and all RE-SAVR patients (p<0.01). Perioperative stroke was not observed after ViV and in 2 patients after RE-SAVR (3.4%, p=0.2). Intensive-care stay was longer after RE-SAVR (3.4±2.9d vs. 1.9±1.8d, p<0.01). Following ViV, 22.5% (n=16) of patients had mild aortic regurgitation, vs. 11.3% (n=8; p=0.25) after RE-SAVR. Mean transvalvular pressure gradients at discharge were higher post ViV (19.3±7.3 vs.12.2±5.6mmHg, p<0.01). Rate of permanent pacemaker implantation was lower after ViV (9.9% vs. 27.1%, p<0.01). Survival at 90- and 180-days was 93.8% and 91.8% vs. 94.4% and 94.4% after ViV and RE-SAVR respectively (p=0.87). Conclusion: Despite a higher risk profile, early mortality was not different between the two treatment arms. Although ViV resulted in elevated postoperative transvalvular pressure gradients and therefore a lower rate of device success, mortality after 180-days was similar to RE-SAVR. At present, both techniques serve as complementary approaches and allow individualized patient care.

scholarly journals Comparison of in-hospital outcomes and readmissions for valve-in-valve transcatheter aortic valve replacement vs. reoperative surgical aortic valve replacement: a contemporary assessment of real-world outcomes

2020 ◽  
Vol 41 (29) ◽  
pp. 2747-2755 ◽  
Author(s):  
Sameer A Hirji ◽  
Edward D Percy ◽  
Cheryl K Zogg ◽  
Alexandra Malarczyk ◽  
Morgan T Harloff ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Aortic Valves ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Valve In Valve

Abstract Aims We sought to perform a head-to-head comparison of contemporary 30-day outcomes and readmissions between valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) patients and a matched cohort of high-risk reoperative surgical aortic valve replacement (re-SAVR) patients using a large, multicentre, national database. Methods and results We utilized the nationally weighted 2012–16 National Readmission Database claims to identify all US adult patients with degenerated bioprosthetic aortic valves who underwent either VIV-TAVR (n = 3443) or isolated re-SAVR (n = 3372). Thirty-day outcomes were compared using multivariate analysis and propensity score matching (1:1). Unadjusted, VIV-TAVR patients had significantly lower 30-day mortality (2.7% vs. 5.0%), 30-day morbidity (66.4% vs. 79%), and rates of major bleeding (35.8% vs. 50%). On multivariable analysis, re-SAVR was a significant risk factor for both 30-day mortality [adjusted odds ratio (aOR) of VIV-SAVR (vs. re-SAVR) 0.48, 95% confidence interval (CI) 0.28–0.81] and 30-day morbidity [aOR for VIV-TAVR (vs. re-SAVR) 0.54, 95% CI 0.43–0.68]. After matching (n = 2181 matched pairs), VIV-TAVR was associated with lower odds of 30-day mortality (OR 0.41, 95% CI 0.23–0.74), 30-day morbidity (OR 0.53, 95% CI 0.43–0.72), and major bleeding (OR 0.66, 95% CI 0.51–0.85). Valve-in-valve TAVR was also associated with shorter length of stay (median savings of 2 days, 95% CI 1.3–2.7) and higher odds of routine home discharges (OR 2.11, 95% CI 1.61–2.78) compared to re-SAVR. Conclusion In this large, nationwide study of matched high-risk patients with degenerated bioprosthetic aortic valves, VIV-TAVR appears to confer an advantage over re-SAVR in terms of 30-day mortality, morbidity, and bleeding complications. Further studies are warranted to benchmark in low- and intermediate-risk patients and to adequately assess longer-term efficacy.

P909Echocardiographic Assessment of Left Ventricular Function in Patients with Aortic Stenosis and the short-term effects after intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Alfarih ◽  
C Leu ◽  
J Moon ◽  
A Hughes ◽  
P Nihoyannopoulos ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
P Value ◽  
Compensatory Mechanisms ◽  
Surgical Aortic Valve Replacement ◽  
The Impact

Abstract Introduction Aortic stenosis (AS) is the most prevalent form of acquired valvular heart disease, it affects ∼2% of people aged over 75. Series of compensatory mechanisms occur, in order for LV to adapt to high pressure overload. Aortic valve replacement has been the mainstay AS treatment either surgically or percutaneously. The evaluation of myocardial strains after Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) is still underexplored and there is no single study to date scouting the difference between TAVI and SAVR. Aim To assess the impact of unloading LV after TAVI and SAVR on LV remodelling. Methods In this prospective study, we have recruited 111 patients (75±11 years, 63% were females) with varying degrees of aortic stenosis. Of the 111 patients, 43 patients and 11 patients underwent TAVI and SAVR respectively between November 2017 and May 2018. Demographics, clinical and echocardiographic measurements along with speckle tracking parameters were recorded for all participants and again 4±2 weeks after intervention. Results Pre-TAVI LV-GLS mean was −10.8±3.5% and after implantation of aortic prosthesis immediate improvement of the myocardial deformation to −13.98±2.9% was observed after one month of the intervention, mean difference of −3.16% following procedure. There was an evidence of significant improvement in LV-GRS after TAVI (44.86±12.9% to 49.77±10.8%, P value= 0.047). Per contra, when comparing pre and post TAVI LV-GCS, no statistical evidence was noted. However, a difference of −2.4% in GCS following the intervention might be clinically important, but no previous evidence can support this. This is attributed to the poor reproducibility and yet not available standardisation. Table 1 Variables TAVI (n=43) SAVR (n=11) P value† Pre Post P* value Pre Post P* value GLS (%) −10.82±3.5 −13.98±2.9 <0.001 −12.75±4.3 −16.1±2 0.021 0.152 GCS (%) −30.1±8.1 −32.49±9.2 0.134 −27±9.8 −33.9±4.69 0.063 0.062 GRS (%) 44.86±12.9 49.77±10.8 0.047 36.6±13.3 44.97±4.9 0.074 0.058 Data are expressed as mean ± SD. Comparisons were performed using paired Student's t tests. *Pre and post intervention. †Post TAVI vs. post SAVR. Comparison done using unpaired t test of the differences. Conclusion Significant improvement was evident in myocardial deformation parameters – in particular GLS – after weeks of the intervention demonstrating a strong evidence of reversed remodelling following SAVR and TAVI.

scholarly journals Comparative survival and role of STS score in aortic paravalvular leak after SAVR or TAVR: a retrospective study from the USA

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022437 ◽  
Author(s):  
Ratnasari Padang ◽  
Mahmoud Ali ◽  
Kevin L Greason ◽  
Christopher G Scott ◽  
Manasawee Indrabhinduwat ◽  
...  
Keyword(s):  
Overall Survival ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Risk Score ◽  
Paravalvular Leak ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Sts Score

ObjectiveThe presence of aortic paravalvular leak (PVL) is associated with lower survival, but a direct comparison of its impact after transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) has not been performed. This study sought to determine the differential influence of PVL on survival following TAVR versus SAVR and in patients with varying levels of risk as defined by the Society of Thoracic Surgeons (STS) risk score.MethodsPatients with and without postprocedural PVL were identified from 2290 patients undergoing TAVR or SAVR at Mayo Clinic between 2008 and 2014. The primary endpoint was overall survival.ResultsThere were 588 patients with PVL (374 TAVR, 214 SAVR): age 78±11 years, 63% male and mean follow-up of 3±2 years. PVL was trivial/mild in 442 (75%) patients. In propensity-matched analyses (n=86 per group), the overall survival at 1 and 4 years was 93% and 56% vs 89% and 61% in patients with PVL after TAVR versus SAVR, respectively (p=0.43). The presence or degree of PVL severity had no influence on survival of patients with high STS score (≥8%), while the presence of greater than mild PVL predicted worse survival in those with STS score <8%. During the first year after PVL diagnosis, while either improvement or stable PVL grade was seen in the majority of patients, worsening of PVL grade was more common in the TAVR group (19%) versus the SAVR group (4%) (p<0.0001).ConclusionsAt mid-term follow-up, the presence of PVL was associated with equally unfavourable outcomes following SAVR or TAVR. In patients with high STS risk score, the presence of PVL was not independently associated with increased mortality.

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