Author + information
- Received July 7, 2011
- Accepted July 21, 2011
- Published online November 1, 2011.
- Holger Eggebrecht, MD⁎,⁎ (, )
- Ulrich Schäfer, MD‡,
- Hendrik Treede, MD§,
- Peter Boekstegers, MD∥,
- Jörg Babin-Ebell, MD¶,
- Markus Ferrari, MD#,
- Helge Möllmann, MD⁎⁎,
- Helmut Baumgartner, MD‡‡,
- Thierry Carrel, MD§§,
- Philipp Kahlert, MD⁎,
- Philipp Lange, MD∥,
- Thomas Walther, MD††,
- Raimund Erbel, MD⁎,
- Rajendra H. Mehta, MD, MS∥∥ and
- Matthias Thielmann, MD†
- ↵⁎Reprint requests and correspondence:
Prof. Dr. Holger Eggebrecht, Cardioangiological Center Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt, Germany
Objectives We sought to analyze outcomes of patients with degenerated surgically implanted bioprosthetic heart valves undergoing valve-in-valve (viv) transcatheter aortic valve implantation (TAVI).
Background Redo cardiac surgery for degenerated bioprosthetic heart valves is associated with increased risks, particular in elderly patients with comorbidities. For these patients, TAVI may be an attractive, less invasive treatment option.
Methods Data from 47 patients age 64 to 97 years (logistic euroSCORE: 35.0 ± 18.5%) undergoing transfemoral (n = 25) or transapical (n = 22) viv-TAVI for failed bioprosthetic aortic valves 113 ± 65 months after initial surgery at 9 clinical sites in Germany and Switzerland were analyzed.
Results Valve-in-valve TAVI was technically successful in all patients, with 2 patients requiring bailout implantation of a second TAVI prosthesis for severe regurgitation during the procedure. There was 1 procedural death as the result of low-output failure. Valvular function after viv-TAVI was excellent with respect to valve competence, but increased transvalvular gradients ≥20 mm Hg were noted in 44% of patients. Vascular access complications occurred in 6 (13%) patients, and 5 (11%) patients required new pacemaker implantation after viv-TAVI. Renal failure requiring dialysis occurred in 4 (9%) patients. Mortality at 30 days was 17% (1 procedural and 7 post-procedural deaths), with 3 of 8 fatalities the result of non–valve-related septic complications.
Conclusions Valve-in-valve TAVI can be performed with high technical success rates, acceptable post-procedural valvular function, and excellent functional improvement. However, in these predominantly elderly high-risk patients with multiple comorbidities, viv-TAVI was associated with 17% mortality, often because of septic complications arising in the post-operative phase.
Dr. Eggebrecht has received honorarium for lectures from Medtronic. Dr. Schäfer is a proctor for Medtronic Inc. and Edwards Lifesciences. Dr. Boekstegers has received consulting fees from Medtronic. Dr. Ferrari is the cofounder of the JenaValve. Dr. Baumgartner is a consultant and proctor for Edwards Lifesciences and AGA Medical Corp.; and a consultant for Actelion. Dr. Kahlert has received minor travel support from Edwards Lifesciences and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 7, 2011.
- Accepted July 21, 2011.
- American College of Cardiology Foundation