Transcatheter aortic valve-in-valve implantation within stentless landing zones: Procedural insights from a single-center experience. Academic Article uri icon

Overview

abstract

  • BACKGROUND: Valve-in-valve (VIV) transcatheter aortic valve implantation (TAVI) is a less invasive therapeutic option compared with redo surgical valve replacement for high-risk patients. Relative to procedures within stented surgical valves, VIV-TAVI within stentless valves is associated with a higher complication rate due to challenging underlying anatomy and absence of fluoroscopic landmarks. AIMS: We share a single-center experience with VIV-TAVI in stentless valves, discussing our procedural insights and associated outcomes. METHODS: Our institutional database was queried, and 25 patients who had undergone VIV-TAVI within a stentless bioprosthesis, homograft, or valve-sparing aortic root replacement between 2013 and 2022 were found. Outcome endpoints were based on the Valve Academic Research Consortium-3 criteria. RESULTS: The mean age of the cohort was 69.5 ± 13.6 years. VIV implantation was performed within a homograft in 11 patients, a stentless bioprothesis in 10 patients, and a valve-sparing aortic root replacement in 4 patients. Nineteen (76%) balloon-expandable valves, 5 (20%) self-expanding valves, and one mechanically-expandable (4%) valve were implanted with 100% procedural success, with no instances of significant paravalvular leak, coronary occlusion, or device embolization. There was one (4%) in-hospitality mortality after an emergency procedure; one (4%) patient experienced a transient ischemic attack; and two (8%) patients required permanent pacemaker implantation. The median length of hospital stay was 2 days. After a median follow-up time of 16.5 months, valve function was acceptable in all patients with available data. CONCLUSION: VIV-TAVI within stentless valves can be safely performed with methodical procedural technique and can provide clinical benefit in patients at high reoperation risk.

authors

  • Lang, Frederick M
  • Mihatov, Nino
  • Kriegel, Jacob
  • Nazif, Tamim M
  • Vahl, Torsten P
  • Ng, Vivian G
  • Lebehn, Mark
  • Blusztein, David
  • Cahill, Thomas J
  • Lehenbauer, Kyle R
  • Hahn, Rebecca T
  • Leon, Martin
  • Kodali, Susheel K
  • George, Isaac

publication date

  • July 2, 2023

Research

keywords

  • Aortic Valve Stenosis
  • Bioprosthesis
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation
  • Transcatheter Aortic Valve Replacement

Identity

Digital Object Identifier (DOI)

  • 10.1002/ccd.30755

PubMed ID

  • 37393603