SPC365

Valve-in-valve transcatheter aortic valve implantation in patients with failed bioprosthetic aortic valves: an analysis of safety, feasibility and clinical outcomes.

Session: Sessão de Posters 26 - TAVI: acessos vasculares
Speaker: Bárbara Lacerda Teixeira

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Cartazes
FP Number: ---
Authors: Bárbara Lacerda Teixeira; Francisco Barbas Albuquerque; Ricardo Carvalheiro; Fernando Ferreira; André Grazina; Tiago Mendonça; Inês Rodrigues; António Fiarresga; Lino Patrício; Ruben Ramos; Duarte Cacela; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Introduction</span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">With the improved durability of newer generations of bioprosthetic valves alongside with the lower bleeding and thromboembolic risks over mechanical valves, they are becoming an attractive alternative to treat severe aortic stenosis in younger patients. As a direct consequence, there is a growing need for redo aortic valve replacement procedures. As redo surgical aortic valve replacement (SAVR) carries a higher risk of procedural complications and intraoperative mortality, valve-in-valve (VIV) transcatheter aortic valve implantation (TAVI) has emerged as an alternative. However, despite the rising frequency of aortic VIV interventions, comprehensive data on their outcomes remains scarce.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Objectives</span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">This analysis aims to evaluate the safety, feasibility and clinical outcomes of valve-in-valve TAVI in patients with failed bioprosthetic aortic valves. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Methods</span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">Retrospective analysis of patients submitted to VIV TAVI in single tertiary center. Baseline characteristics, failed bioprosthesis characterization and procedure data were noted. Procedural success and clinical outcomes were defined according to the Valve Academic Research Consortium-2 (VARC-2).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Results</span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">From 2015 to 2022, 34 patients (52.9% female, mean age 81 years old) underwent VIV TAVI for symptomatic failed bioprosthetic aortic valves (38% stenosis, 47% regurgitation, 15% mixed dysfunction), with intermediate to high surgical risk (Euroscore II 14.3 &plusmn; 11.1 and STS score 8.1 &plusmn; 5.6). Baseline characteristics and procedure data are depicted in table 1. Among our cohort, more commonly found degenerated valves were Mitroflow (Sorin), Trifecta (St Jude Medical) and Perimount (Edwards Lifesciences). The most used TAVI valve was the Corevalve (Medtronic) in 88% and the most used valve sized was nr 23. Periprocedural percutaneous coronary intervention was performed in 15% of the cases and coronary protection techniques were performed in 12%. Procedural success and outcomes are shown in table 2. As described in previous studies, device success rate is lower than in non-VIV procedures, at cost of valve performance, mainly higher mean gradients. No intraprocedural deaths, valve malaposition/migration or coronary occlusion were registered. Overall mortality at 30-day and 1-year was <span style="color:black">0% </span>and 11.7%, with only 5.9% cardiovascular mortality. <span style="color:black">No major vascular complication, major bleeding, stroke or permanent pacemaker implantation were registered at 30 days after the procedure. No prosthetic dysfunction or thrombosis was seen at 1 year. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Conclusions</span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">In a real word cohort of intermediate- and high- surgical risk patients with failed bioprosthetic valves, VIV TAVI procedure has showed to be a feasible, safe and efficient treatment, with good clinical outcomes and low rates of peri-procedural complications.</span></span></span></span></p>