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Feasibility and prognostic impact of transcatheter aortic valve implantation (TAVI) for bioprosthetic aortic valve failures (valve in valve procedure): a single center experience

Session Poster session 3

Speaker Manuela Muratori

Congress : EuroEcho-Imaging 2017

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Non-coronary Cardiac Intervention
  • Session type : Poster Session
  • FP Number : P811

Authors : M Muratori (Milan,IT), L Fusini (Milan,IT), G Tamborini (Milan,IT), P Gripari (Milan,IT), S Ghulam Ali (Milan,IT), E Stefanini (Milan,IT), L Salvi (Milan,IT), F Fabbiocchi (Milan,IT), M Roberto (Milan,IT), P Trabattoni (Milan,IT), M Agrifoglio (Milan,IT), AL Bartorelli (Milan,IT), F Alamanni (Milan,IT), M Pepi (Milan,IT)

Authors:
M Muratori1 , L Fusini1 , G Tamborini1 , P Gripari1 , S Ghulam Ali1 , E Stefanini1 , L Salvi1 , F Fabbiocchi1 , M Roberto1 , P Trabattoni1 , M Agrifoglio1 , AL Bartorelli1 , F Alamanni1 , M Pepi1 , 1Centro Cardiologico Monzino IRCCS - Milan - Italy ,

Citation:
European Heart Journal Supplements ( 2017 ) 18 ( Supplement 3 ), iii199

Background. Aortic valve replacement with biological valves are increasingly used in patients with aortic stenosis. Considering the limited durability of biological valves, a redo surgery remains the current standard of care for failed prosthetic valves. However, elderly patients are frequently denied surgery because of the high risk of major adverse events related to repeat cardiac surgery. The promising results of transcatheter aortic valve implantation (TAVI) in high-risk patients with aortic stenosis have encouraged the development of TAVI valve in valve (ViV) procedures for failed biological prosthesis.
Purpose. The aim of this study was to investigate feasibility, haemodynamic performance and prognostic impact of TAVI-ViV.
Methods. A total of 46 patients (age 78±11 years, 22 male), who underwent TAVI-ViV due to failed aortic biological valve, was enrolled. In all patients, echocardiographic and clinical assessment were performed at baseline, post-procedure, and at 1-year (1Y) follow-up. The mechanism of bioprosthetic valve failure was stenosis (27 cases), regurgitation (11) or combination (8). Procedures were performed via transfemoral access using a balloon-expandable SAPIEN valve (26 cases) or self-expandable CoreValve or Portico valves (20 cases).
Results. TAVI-ViV was feasible in 45 patients (98%). In 1 case the procedure failed requiring a conversion to open cardiac surgery. The rate of new peri-procedural permanent pacemaker implantation was 9%. Major stroke rate was 2%. The mortality rate was 4% (2 patients) at 30 days and 11% (5 patients) at 1Y. New York Heart Association functional class was improved at 1Y follow up (NYHA III/IV: baseline, 89%; 1Y, 3%; p<0.001). A significant reduction in mean (baseline: 41±18mmHg, post-procedure: 17±8mmHg, p<0.001) and peak aortic pressure gradient (baseline: 67±25mmHg, post-procedure: 30±15mmHg, p<0.001) was observed immediately after TAVI-ViV. No significant increase in mean aortic pressure gradient was reported at 1Y (mean aortic pressure gradient: 19±10mmHg, p=0.275). More than mild paravalvular aortic regurgitation occurred in 8 patients out of 20 (40%) with a self-expandable valve and in 2 patients out of 26 (8%) with a balloon-expandable (p=0.012) valve immediately after the procedure and remained unchanged at 1Y.
Conclusions. TAVI ViV was feasible in majority of cases. Despite mean transprosthetic gradient higher than expected for a TAVI in a native valve, TAVI ViV resolved prosthetic dysfunction with significant improvement in NYHA functional class.  Therefore, this procedure represents a promising new option for patients with failed prosthetic valves.



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