Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the global valve-in-valve registry.

MedStar author(s):
Citation: Circulation. 126(19):2335-44, 2012 Nov 6.PMID: 23052028Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Evaluation Studies | Journal Article | Multicenter Study | Research Support, Non-U.S. Gov'tSubject headings: *Aortic Valve/su [Surgery] | *Bioprosthesis/ae [Adverse Effects] | *Equipment Failure/sn [Statistics & Numerical Data] | *Heart Valve Prosthesis Implantation/mt [Methods] | *Heart Valve Prosthesis/ae [Adverse Effects] | *Registries | *World Health/sn [Statistics & Numerical Data] | Aged | Aged, 80 and over | Aortic Valve Insufficiency/ep [Epidemiology] | Aortic Valve Insufficiency/et [Etiology] | Aortic Valve Insufficiency/su [Surgery] | Aortic Valve Stenosis/ep [Epidemiology] | Aortic Valve Stenosis/et [Etiology] | Aortic Valve Stenosis/su [Surgery] | Cardiac Catheterization/ae [Adverse Effects] | Cardiac Catheterization/mt [Methods] | Female | Follow-Up Studies | Heart Valve Prosthesis Implantation/ae [Adverse Effects] | Humans | Incidence | Male | Reoperation | Retrospective Studies | Treatment OutcomeLocal holdings: Available online from MWHC library: 1950 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0009-7322
Name of journal: CirculationAbstract: BACKGROUND: Transcatheter aortic valve-in-valve implantation is an emerging therapeutic alternative for patients with a failed surgical bioprosthesis and may obviate the need for reoperation. We evaluated the clinical results of this technique using a large, worldwide registry.CONCLUSIONS: The valve-in-valve procedure is clinically effective in the vast majority of patients with degenerated bioprosthetic valves. Safety and efficacy concerns include device malposition, ostial coronary obstruction, and high gradients after the procedure.METHODS AND RESULTS: The Global Valve-in-Valve Registry included 202 patients with degenerated bioprosthetic valves (aged 77.7+/-10.4 years; 52.5% men) from 38 cardiac centers. Bioprosthesis mode of failure was stenosis (n=85; 42%), regurgitation (n=68; 34%), or combined stenosis and regurgitation (n=49; 24%). Implanted devices included CoreValve (n=124) and Edwards SAPIEN (n=78). Procedural success was achieved in 93.1% of cases. Adverse procedural outcomes included initial device malposition in 15.3% of cases and ostial coronary obstruction in 3.5%. After the procedure, valve maximum/mean gradients were 28.4+/-14.1/15.9+/-8.6 mm Hg, and 95% of patients had <=+1 degree of aortic regurgitation. At 30-day follow-up, all-cause mortality was 8.4%, and 84.1% of patients were at New York Heart Association functional class I/II. One-year follow-up was obtained in 87 patients, with 85.8% survival of treated patients.All authors: Abdel-Wahab M, Baumbach A, Bekeredjian R, Bleiziffer S, Brecker S, Colombo A, De Marco F, Descoutures F, Dumonteil N, Dvir D, Fiorina C, Gotzmann M, Guetta V, Hengstenberg C, Hernandez JM, Hildick-Smith D, Kornowski R, Laborde JC, Lefevre T, Moat NE, Napodano M, Nissen H, Roy D, Segev A, Tchetche D, Teles RC, Testa L, Webb JDigital Object Identifier: Date added to catalog: 2013-09-17
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Journal Article MedStar Authors Catalog Article Available 23052028

Available online from MWHC library: 1950 - present, Available in print through MWHC library: 1999 - 2006

BACKGROUND: Transcatheter aortic valve-in-valve implantation is an emerging therapeutic alternative for patients with a failed surgical bioprosthesis and may obviate the need for reoperation. We evaluated the clinical results of this technique using a large, worldwide registry.

CONCLUSIONS: The valve-in-valve procedure is clinically effective in the vast majority of patients with degenerated bioprosthetic valves. Safety and efficacy concerns include device malposition, ostial coronary obstruction, and high gradients after the procedure.

METHODS AND RESULTS: The Global Valve-in-Valve Registry included 202 patients with degenerated bioprosthetic valves (aged 77.7+/-10.4 years; 52.5% men) from 38 cardiac centers. Bioprosthesis mode of failure was stenosis (n=85; 42%), regurgitation (n=68; 34%), or combined stenosis and regurgitation (n=49; 24%). Implanted devices included CoreValve (n=124) and Edwards SAPIEN (n=78). Procedural success was achieved in 93.1% of cases. Adverse procedural outcomes included initial device malposition in 15.3% of cases and ostial coronary obstruction in 3.5%. After the procedure, valve maximum/mean gradients were 28.4+/-14.1/15.9+/-8.6 mm Hg, and 95% of patients had <=+1 degree of aortic regurgitation. At 30-day follow-up, all-cause mortality was 8.4%, and 84.1% of patients were at New York Heart Association functional class I/II. One-year follow-up was obtained in 87 patients, with 85.8% survival of treated patients.

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