Short- and Medium-Term Outcomes Comparison of Native- and Valve-in-Valve TAVI Procedures

TL;DR

This study compares the outcomes of valve-in-valve and native valve TAVI procedures and finds similar clinical results, though valve-in-valve had higher initial pressure gradients.

Contribution

The study provides a comparison of short- and medium-term outcomes between ViV-TAVI and NV-TAVI using a propensity score-matched cohort.

Findings

ViV-TAVI and NV-TAVI had comparable clinical outcomes, including device success and mortality rates.

ViV-TAVI showed significantly higher immediate post-intervention mean residual aortic valve gradients.

There were no significant differences in all-cause or cardiovascular mortality at 12 or 30 months.

Abstract

In high-risk patients with degenerated aortic
bioprostheses, valve-in-valve (ViV) transcatheter aortic valve implantation
(TAVI) has emerged as a less invasive alternative to surgical valve replacement.
To compare outcomes of ViV and native valve (NV) TAVI
procedures.

34 aortic ViV-TAVI performed between 2012 and 2022
using self-expanding valves, were included in this retrospective analysis.
Propensity score matching (1:2 ratio, 19 criteria) was used to select a
comparison NV-TAVI group from a database of 1206 TAVI procedures. Clinical and
echocardiographic endpoints, short- and long-term all-cause mortality (ACM) and
cardiovascular mortality (CVM) data were obtained. Subgroup analyses were
completed according to the true internal diameter, dividing patients into a small
(≤19 mm) valve group (SVG) and a large (>19 mm) valve group
(LVG).

Clinical outcomes of ViV- and NV-TAVI were comparable,
including device success [88.2% vs. 91.1%, p = 0.727], major adverse
cardiovascular and cerebrovascular events [5.8% vs. 5.8%, p = 1.000],
hemodialysis need [5.8% vs. 2.9%, p = 0.599], pacemaker need [2.9%
vs. 11.7%, p = 0.265], major vascular complications [2.9% vs. 1.4%,
p = 1.000], life-threatening or major bleeding [2.9% vs. 1.4%,
p = 1.000] and in-hospital mortality [8.8% vs. 5.9%, p =
0.556]. There was a significant difference in the immediate post-intervention
mean residual aortic valve gradient (MAVG) [14.6 ± 8.5 mm Hg vs. 6.4
± 4.5 mm Hg, p < 0.0001], which persisted at 1 year [p = 0.0002]. There were no differences in 12- or 30-month ACM [11.8% vs. 8.8%,
p = 0.588; 23.5% vs. 27.9%, p = 0.948], and CVM [11.8% vs.
7.3%, p = 0.441; 23.5% vs. 16.2%, p = 0.239]. Lastly, there
was no difference in CVM at 1 year and 30 months [11.1% vs. 12.5%, p =
0.889; 22.2% vs. 25.0%, p = 0.742].

Analyzing a
limited group (n = 34) of ViV-TAVI procedures out of 1206 TAVIs done at a single
institution, ViV-TAVI appeared to be an acceptable approach in patients not
deemed appropriate candidates for redo valve replacement surgery. Clinical
outcomes of ViV-TAVI were comparable to TAVI for native valve stenosis.

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