SPC365

Valve-in-valve TAVI for failing surgical aortic bioprosthetic valves: a single-centre experience

Session: Comunicações Orais (Sessão 7) - Intervenção Cardíaca Coronária e Estrutural 1 - Válvula Aórtica
Speaker: Mariana Ribeiro Silva

Congress: CPC 2022
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Comunicações Orais
FP Number: ---
Authors: Mariana Ribeiro Silva; Alberto Rodrigues; Cláudio Guerreiro; Gualter Santos Silva; Pedro Ribeiro Queirós; Mariana Brandão; Diogo Ferreira; Gustavo Pires Morais; Bruno Melica; Lino Santos; Pedro Braga; Ricardo Fontes-Carvalho

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Introduction: </span></strong><span style="color:black">Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is an alternative to redo surgery for surgical bioprosthetic (BP) valve deterioration. T</span>he clinical experience with this approach is gradually increasing.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Objectives: </span></strong><span style="color:black">To assess<strong> </strong></span><span style="color:#212121">periprocedural and short-term outcomes in patients (pts) undergoing ViV TAVI for degenerated surgical aortic BP valves.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Methods:</span></strong><span style="color:black"> Single-centre retrospective study of consecutive pts undergoing ViV TAVI for failed surgical aortic BP valves between 2007 and 2019. Data were analysed </span><span style="color:#212121">regarding periprocedural events according to </span>the Valve Academic Research Consortium 2 criteria <span style="color:#212121">and 30-day and 1-year outcomes.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Results: </span></strong><span style="color:black">TAVI was implanted in 705 pts, of which 43 (6,1%) were ViV TAVI procedures. Most pts were female (51,2%), with a mean age of 75,7&plusmn;11,2 years, median EuroSCORE II of 8,8% (IQR 4,7-10,5%). Prior surgical aortic BP were implanted for a mean 8,0&plusmn;3,2 years with a label size &le;21mm in 66% pts. Surgical BP dysfunction was due to regurgitation (AR), stenosis or a combination of both in 21 (48,8%), 18 (41,9%) or 4 pts (9,3%), respectively.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">At the time of the intervention, the majority of pts were in NYHA-class &ge;III (70%), with 47% treated as urgent interventions.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">All pts were treated via transfemoral approach, the majority (84%; n=36) with self-expandable TAVI. ViV TAVI procedural success rate was 98%. Intraprocedural coronary artery obstruction occurred in one pt. Periprocedural adverse events included major vascular complication (7%), major bleeding (7%), stroke (7%), acute kidney injury (19%) and permanent pacemaker implantation (PPI) (2,5%). There was 1 in-hospital death due to cardiogenic shock because of left main coronary artery obstruction.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">At discharge, mean aortic gradient (MAVG) was 20,4&plusmn;10mmHg, with 45% of the pts presenting MAVG&ge;20 mmHg and 12% AR grade&ge;II. At 30-day follow-up, no death or heart failure hospital admission was reported.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">One-year after the procedure, 89% of the pts were in NYHA class I-II; MAVG remained unchanged at 1-year in the majority of pts and 19% had AR grade &ge;II. One pt needed PPI and 3 pts were hospitalized due to acute heart failure in this follow-up period. One-year mortality was 7,1%.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Conclusions: </span></strong><span style="color:black">In our population,<strong> </strong>ViV TAVI in degenerated surgical aortic BP was a safe procedure with persistence of favorable clinical results at 30-day and 1-year follow-up in this high-risk population.</span></span></span></p>