Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2019 May 1;93(6):1106-1115.
doi: 10.1002/ccd.28039. Epub 2018 Dec 27.

A comparison of valve-in-valve transcatheter aortic valve replacement in failed stentless versus stented surgical bioprosthetic aortic valves

Charles H Choi  1 , Vivian Cheng  1 , Diego Malaver  1 , Neal Kon  2 , Edward H Kincaid  2 , Sanjay K Gandhi  1 , Robert J Applegate  1 , David X M Zhao  1
Affiliations
Observational Study

A comparison of valve-in-valve transcatheter aortic valve replacement in failed stentless versus stented surgical bioprosthetic aortic valves

Charles H Choi et al. Catheter Cardiovasc Interv. .

Abstract

Objectives: The objectives of this study were to compare short- and intermediate-term clinical outcomes, procedural complications, TAVR prosthesis hemodynamics, and paravalvular leak (PVL) in stentless and stented groups.

Background: Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is an alternative to surgical redo for bioprosthetic valve failure. There have been limited data on ViV in stentless surgical valves.

Methods: We retrospectively analyzed 40 patients who underwent ViV TAVR in prior surgical bioprosthetic valves at Wake Forest Baptist Medical Center from October 2014 to September 2017. Eighty percent (32/40) ViV TAVRs were in stentless, while 20% (8/40) were in stented bioprosthetic valves.

Results: The primary mode of bioprosthetic valve failure for ViV implantation in the stentless group was aortic insufficiency (78%, 25/32), while in the stented group was aortic stenosis (75%, 6/8). The ViV procedure success was 96.9% (31/32) in stentless group and 100% in stented group (8/8). There were no significant differences in all-cause mortality at 30 days between stentless and stented groups (6.9%, 2/31 versus 0%, 0/8, P = 0.33) and at 1 year (0%, 0/25 versus 0%, 0/5). In the stentless group, 34.4% (11/32) required a second valve compared to the stented group of 0% (0/8). There was a significant difference in the mean aortic gradient at 30-day follow-up (12.33 ± 6.33 mmHg and 22.63 ± 8.45 mmHg in stentless and stented groups, P < 0.05) and at 6-month follow-up (9.75 ± 5.07 mmHg and 24.00 ± 11.28 mmHg, P < 0.05), respectively.

Conclusions: ViV in the stentless bioprosthetic aortic valve has excellent procedural success and intermediate-term results. Our study shows promising data that may support the application of TAVR in stentless surgical aortic valve. However, further and larger studies need to further validate our single center's experience.

Keywords: aortic valve replacement; homograft; stented; stentless; transcatheter aortic valve implantation.

PubMed Disclaimer

Conflict of interest statement

All authors confirm that no conflicts of interest exist for this manuscript, the manuscript represents valid work and that neither this manuscript nor one with substantially similar content under their authorship has been or is being considered for publication elsewhere.

Figures

Figure 1
Figure 1
Longitudinal change in ejection fraction (%). This figure displays the average ejection fraction at each follow‐up and P‐values for the change in ejection fraction between follow‐up periods
Figure 2
Figure 2
Mean aortic valve gradient comparison. This figure compares the mean aortic valve gradients (mmHg) and aortic valve area (AVA) from preoperative period to 12‐month follow‐up in both the stented (blue) and stentless (red) groups
Figure 3
Figure 3
Comparison of paravalvular leak (PVL) severity. This figure compares the paravalvular leak from preoperative period to 12‐month follow‐up in both the stented and stentless group
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Gurvitch R, Cheung A, Ye J, et al. Transcatheter valve‐in‐valve implantation for failed surgical bioprosthetic valves. J Am Coll Cardiol. 2011;58:2196‐2209. - PubMed
    1. Kobayashi J. Stentless aortic valve replacement: An update. Vasc Health Risk Manage. 2011;7:345‐351. - PMC - PubMed
    1. Jones JM, O'kane H, Gladstone DJ, et al. Repeat heart valve surgery: Risk factors for operative mortality. J Thorac Cardiovasc Surg. 2001;122:913‐918. - PubMed
    1. Dvir D, Webb J, Brecker S, et al. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: Results from the global valve‐in‐valve registry. Circulation. 2012;126:2335‐2344. - PubMed
    1. Camboni D, Holzamer A, Flörchinger B, et al. Single‐institution experience with transcatheter valve‐in‐valve implantation emphasizing strategies for coronary protection. Ann Thorac Surg. 2015;99:1532‐1538. - PubMed

Publication types

MeSH terms

  NODES
design 1
eth 4
see 3
Story 1
twitter 2