| Institution: | 1. Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York, USA;2. University of British Columbia and St. Paul’s Hospital, Vancouver, Canada;3. Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Department of Medicine, Laval University, Québec, Canada;4. Heart Valve Unit, Haut-Leveque Cardiologic Hospital, Bordeaux University, Pessac, France;5. Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA;6. Cleveland Clinic, Cleveland, Ohio, USA;7. Jesselson Integrated Heart Center, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel;8. Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA;9. Department of Cardiothoracic Surgery, Piedmont Heart Institute, Atlanta, Georgia, USA;10. NYU Langone Medical Center, New York, New York, USA;11. Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA;12. Department of Cardiology, Institut Pasteur de Lille, CHU Lille, Lille, France;13. Edwards Lifesciences, Irvine, California, USA;14. Baylor Scott & White Health, Dallas, Texas, USA |
| Abstract: | ObjectivesThe aim of this study was to report the outcomes of valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) at 5 years.BackgroundTAVR for degenerated surgical bioprostheses in patients at high risk for reoperative surgery is an important treatment option that may delay or obviate the need for surgical intervention; however, long-term outcomes of this procedure are unknown.MethodsThe PARTNER (Placement of Aortic Transcatheter Valves) 2 ViV and continued access registries prospectively enrolled patients with failed surgical bioprostheses at high risk for reoperation. Five-year clinical and echocardiographic follow-up data were obtained in 95.9% of patients.ResultsIn 365 (96 registry and 269 continued access) patients, the mean age was 78.9 ± 10.2 years, the mean Society of Thoracic Surgeons predicted risk of surgical mortality score was 9.1 ± 4.7%, and New York Heart Association functional class was III or IV in 90.4%. At 5 years, the Kaplan-Meier rates of all-cause mortality and any stroke were 50.6% and 10.5%, respectively. Using Valve Academic Research Consortium 3 definitions, the incidence of structural valve deterioration, related hemodynamic valve deterioration, or bioprosthetic valve failure at 5 years was 6.6%. Aortic valve re-replacement was performed in 6.3% (n = 14), the majority of which was due to stenosis (n = 6) and combined aortic insufficiency/paravalvular regurgitation (n = 3). The mean gradient, Doppler velocity index, paravalvular regurgitation, and quality of life measured by Kansas City Cardiomyopathy Questionnaire scores in survivors remained stable from 30 days postprocedure through 5 years.ConclusionsAt the 5-year follow-up, TAVR for bioprosthetic aortic valve failure in high surgical risk patients was associated with sustained improvement in clinical and echocardiographic outcomes. |
