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.