Redo Aortic Valve Replacement for Degenerated Bioprostheses: Risks and Outcome in the Transcatheter Valve Era

Objectives: This study evaluates reinterventions for degenerated aortic xenografts before and after the introduction of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI).

Methods: From 2005–2015, 110 consecutive patients (median age 73 years [IQR 65–78 years], median EuroSCORE II 8.4% [IQR 5.2–15.8%]) underwent reintervention for failed aortic bioprostheses. Analysis was based on redo surgery from 2005–2009 (Group A, n = 26), redo surgery from 2010–2015 (Group B, n = 38), and ViV-TAVI from 2010–2015 (Group C, n = 46). Median follow-up was 36 months (IQR 28.8–36.0 months).

Results: Median EuroSCORE II increased significantly within ten years: 5.8% (IQR 4.7–9.1%) in group A, 7.0% (IQR 4.0–15.8%) in group B, and 10.1% (IQR 7.0–16.5%) in group C (p = 0.04). With 57.9% of group B patients undergoing combined surgery (group A 38.5%, group C 4.3%, p < 0.001), the complexity of the procedure increased. Valve implantation was successful in all surgical and in 87% transcatheter cases. Early mortality (30 days) was 9.1% overall; 3.8% in group A, 10.5% in group B, and 10.9% in group C (p = 0.59). It was associated with female gender, age ≥80 years, the necessity for prolonged mechanical circulatory support, perioperative renal failure, respiratory failure requiring reintubation, and inotropics and/or vasopressors required for >48 hours. Three-year survival was 83.6% overall, 96.2% in group A, 78.9% in group B, and 80.4% in group C (p = 0.17).

Conclusion: There was an increase in patient's risk and complexity of surgery in recent years. Outcome of ViV-TAVI in selected high-risk patients is comparable with redo surgery, but limitations and potential complications must be considered.