Short-Term Outcome of Redo Aortic Valve and Transcatheter Valve-in-Valve Replacement for Failing Stentless Aortic Valve Prostheses: A Single-center Experience

Objectives: This study aimed to evaluate outcome after conventional and transcatheter aortic valve-in-valve replacement of a single stentless aortic valve prosthesis. To our best knowledge, we report the biggest combined series of interventional and surgical valve replacement in this failing commercial stentless aortic valve prosthesis.

Methods: We reviewed 104 patients with a single type of commercial stentless aortic valve prosthesis who underwent conventional redo aortic valve replacement (re-AVR) or transcatheter aortic valve-in-valve replacement (TAVR-VIV) from January 2012 to October 2019 at MediClin Heart Center Lahr/Baden, Germany. Patients who had active endocarditis or who underwent concomitant heart surgery or redo operation within six weeks were excluded, as were those who received mechanical aortic valve prostheses. One TAVR-VIV procedure was converted to a conventional procedure due to a valve migration. The analysis was performed as-treated.

Result: Overall, 56 patients were analyzed, 37 (66.1%) in the TAVR-VIV group and 19 (33.9%) in the re-AVR group. Patients in the TAVR-VIV group were older, had a higher EuroSCORE II, and had moderately dilated left ventricles compared with the re-AVR group (75.0 ± 8.0 vs. 62.0 ± 11.4 years, p < 0.01; 9.7 ± 6.4 vs. 4.3 ± 2.2%, p < 0.01; and 57.9 ± 7.2 vs. 63.4 ± 5.5 mm, p < 0.01). On analysis, 30-day and 6-month survival rates were similar in both groups (100%). Early postoperative echocardiographic results were good in both the TAVR-VIV and re-AVR groups, with the mean transvalvular gradient at 12.7 ± 5.0 vs. 11.5 ± 4.2 mm Hg (p = 0.372), a mild paravalvular leak in 18.9% versus 10.5% (p = 0.703), and no moderate or severe paravalvular leak. The number of new permanent pacemakers implanted, and myocardial infarctions was higher in the TAVR-VIV group but did not reach statistical significance, at 6/31 (19.4%) vs. 0/17 (0%) (p = 0.077) and 2.7 vs. 0% (p = 1.000).

Conclusion: The early survival rates of the two groups were excellent, irrespective of baseline characteristics. Both groups also showed promising early postoperative echocardiographic outcomes. TAVR-VIV with this type of commercial stentless biological aortic valve prosthesis could be a feasible alternative to re-AVR, especially in elderly patients.

Publication History

Article published online:
19 February 2021