Five-Year Follow-Up from the CoreValve Expanded Use Transcatheter Aortic Valve-in-Surgical Aortic Valve Study.

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

Transcatheter aortic valve replacement (TAVR) provides an option for extreme-risk patients undergoing reoperation for a failed surgical aortic bioprosthesis. Long-term data in patients undergoing TAVR within a failed surgical aortic valve (TAV-in-SAV) are limited. The CoreValve Expanded Use Study evaluated patients at extreme surgical risk undergoing TAV-in-SAV. Outcomes at 5 years were analyzed by SAV failure mode (stenosis, regurgitation, or combined). Echocardiographic outcomes are site reported. TAV-in-SAV was attempted in 226 patients with a mean age of 76.7+/-10.8 years; 63.3% were male, the Society of Thoracic Surgeons predicted risk of mortality score was 9.0+/-6.7%, and 87.5% had NYHA classification III or IV symptoms. Most of the failed surgical bioprostheses were stented (81.9%), with an average implant duration of 10.2+/-4.3 years. The 5-year all-cause mortality or major stroke rate was 47.2% in all patients; 54.4% in the stenosis, 37.6% in the regurgitation, and 38.0% in the combined groups (p=0.046). At 5 years, all-cause mortality was higher in patients with vs without 30-day severe prosthesis patient mismatch (51.7% vs 38.3%, p=0.026). The overall aortic-valve reintervention rate was 5.9%; highest in the regurgitation group (12.6%). The mean aortic-valve gradient was 14.1+/-9.8mm Hg and effective orifice area was 1.57+/-0.70 at 5 years. Few patients had >mild paravalvular regurgitation at 5 years (5.5% moderate, 0.0% severe). TAV-in-SAV with supra-annular, self-expanding TAVR continues to represent a safe and lasting intermediate option for extreme-risk patients who have appropriate sizing of the preexisting failed surgical valve. Clinical and hemodynamic outcomes were stable through 5 years. Copyright © 2023. Published by Elsevier Inc.

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