Author + information
- Received August 3, 2018
- Revision received February 14, 2019
- Accepted February 19, 2019
- Published online June 12, 2019.
- Alison Duncan, MDa,∗ (, )
- Neil Moat, MDa,
- Matheus Simonato, MDb,
- Arend de Weger, MDc,
- Jorg Kempfert, MDd,
- Holger Eggebrecht, MDe,
- Antony Walton, MDf,
- Farrel Hellig, MDg,
- Ran Kornowski, MDh,
- Konstantinos Spargias, MDi,
- Oscar Mendiz, MDj,
- Raj Makkar, MDk,
- Mayra Guerrero, MDl,
- Charanjit Rihal, MDl,
- Isaac George, MDm,
- Creighton Don, MDn,
- Alessandro Iadanza, MDo,
- Vinayak Bapat, MDm,
- Robert Welsh, MDp,
- Harindra C. Wijeysundera, MDq,
- David Wood, MDr,
- Janarthanan Sathananthan, MDs,
- Haim Danenberg, MDt,
- Francesco Maisano, MDu,
- Santiago Garcia, MDv,
- Sameer Gafoor, MDw,
- Luis Nombela-Franco, MDx,
- Javier Cobiella, MDx and
- Danny Dvir, MDn
- aRoyal Brompton Hospital, London, United Kingdom
- bEscola Paulista de Medicina – UNIFESP, São Paulo, Brazil
- cLeids Universitair Medisch Centrum, Leiden, the Netherlands
- dDeutsches Herzzentrum Berlin, Berlin, Germany
- eCardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
- fAlfred Health, Melbourne, Australia
- gSunninghill Hospital, Johannesburg, Republic of South Africa
- hRabin Medical Centre, Petah Tikva, Israel
- iHygeia Hospital, Athens, Greece
- jFundación Favaloro, Buenos Aires, Argentina
- kCedars-Sinai Medical Centre, Los Angeles, California
- lMayo Clinic, Rochester, Minnesota
- mColumbia University, New York, New York
- nUniversity of Washington, Seattle, Washington
- oAzienda Ospedaliera Universitaria Senese, Siena, Italy
- pUniversity of Alberta, Edmonton, Alberta, Canada
- qSunnybrook Hospital, Toronto, Ontario, Canada
- rVancouver General Hospital, Vancouver, British Columbia, Canada
- sSt. Paul’s Hospital, Vancouver, British Columbia, Canada
- tHadassah Medical Center, Jerusalem, Israel
- uUniversitätsspital Zürich, Zürich, Switzerland
- vUniversity of Minnesota, Minneapolis, Minnesota
- wSwedish Hospital, Seattle, Washington
- xHospital Clinico San Carlos, Madrid, Spain
- ↵∗Address for correspondence:
Dr. Alison Duncan, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, United Kingdom.
Objectives A large comprehensive analysis of transcatheter aortic valve replacement (TAVR) was performed for failed stentless bioprostheses.
Background Valve-in-valve (ViV) transcatheter aortic replacement (TAVR) is an alternative to redo surgery for patients with a failing aortic bioprosthesis.
Methods Unadjusted outcome data were collected from the VIVID (Valve-in-Valve International Data) registry between 2007 and 2016 from a total of 1,598 aortic ViV procedures (291 stentless, 1,307 stented bioprostheses).
Results Bioprosthetic failure was secondary to aortic regurgitation in 56% of stentless and 20% stented devices (p < 0.001). ViV-TAVR access was transfemoral in 71.1% stentless and 74.2% stented ViV-TAVR. Self-expanding devices were more frequently used in stentless ViV-TAVR (56.0% vs. 39.9%; p = 0.05), but there was no difference between balloon-expanding and self-expanding TAVR devices for stented ViV-TAVR (48.6% vs. 45.1%). The degree of oversizing for all mechanisms of bioprosthesis failure was 9 ± 10% for stentless ViV-TAVR vs. 6 ± 9% for stented ViV-TAVR (and 8 ± 10% for stentless ViV-TAVR vs. 3 ± 9% for stented ViV-TAVR in patients with predominant aortic regurgitation; both p < 0.001). Initial device malposition (10.3% vs. 6.2%; p = 0.014), second transcatheter device (7.9% vs. 3.4%), coronary obstruction (6.0% vs. 1.5%), and paravalvular leak occurred more frequently in stentless ViV-TAVR (all p < 0.001). Hospital stay duration (median 7 days) was no different, and 30-day (6.6% vs. 4.4%; p = 0.12) and 1-year mortality year (15.8% vs. 12.6%; p = 0.15) were numerically higher, but not statistically different, after stentless ViV-TAVR.
Conclusions Stentless ViV-TAVR is associated with greater periprocedural complications (initial device malposition, second transcatheter device, coronary obstruction, paravalvular leak), but no difference in 30-day and 1-year outcome.
Dr. Moat has been a consultant for Medtronic; and is now an employee of Abbott. Dr. Kempfert has been a proctor/speaker for Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott. Dr. Walton has received grant support from Medtronic, Abbott, and Edwards Lifesciences; has been a proctor for Medtronic and Abbott; and has served on a medical advisory board for Medtronic. Dr. Hellig has been a proctor for Edwards Lifesciences, Medtronic, and Boston Scientific. Dr. Spargias has been a proctor to Edwards Lifesciences and Medtronic. Dr. Mendiz has been a consultant to Medtronic and Abbott; and has been a speaker for Biosensors. Dr. Makkar has been a consultant to/grant recipient from Cordis, Medtronic, Abbott, and Edwards Lifesciences. Dr. Guerrero has been a proctor for and received grant support from Edwards Lifesciences; and has been a speaker for Boston Scientific. Dr. Rihal has been a consultant to and received grant support from Edwards Lifesciences. Dr. George has been a consultant to Medtronic and Edwards Lifesciences. Dr. Bapat has been a consultant to Medtronic. Dr. Walsh has received research grants and honoraria from AstraZeneca, Bayer, Brristol-Myers Squibb/Pfizer, Boehringer Ingelheim, and Edwards Lifesciences. Dr. Wijeysundera has received research funding from Medtronic and Edwards Lifesciences. Dr. Woods has received grant support from Abbott and Edwards Lifesciences; and has been a consultant to Boston Scientific and Medtronic. Dr. Maisano has been a consultant to Abbott, Edwards Lifesciences, Medtronic, Cardiovalve, and Valtech; has received research grants from Abbott, Edwards Lifesciences, Medtronic, Biotronik, and Boston Scientific; and is cofounder of 4Tech and TSP Medical. Dr. Garcia has been a consultant to Abbott and; and has received research grants from Edwards Lifesciences. Dr. Gafoor has been a consultant/proctor for Medtronic, Abbott Vascular, and Boston Scientific. Dr. Nombela-Franco has been a proctor for Abbott; and has received speakers honoraria from Edwards Lifesciences. Dr. Dvir has been a consultant to Edwards Lifesciences and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 3, 2018.
- Revision received February 14, 2019.
- Accepted February 19, 2019.
- 2019 American College of Cardiology Foundation
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