# The International TrifectaTM and EpicTM Valve‐in‐Valve Registry: Insights Into Clinical & Hemodynamic Outcomes

## TL;DR

This study compares the outcomes of valve-in-valve TAVR in two types of failed aortic valves, finding that Trifecta valves have lower risks of complications and better patient outcomes.

## Contribution

The study provides the first international comparison of clinical and hemodynamic outcomes for ViV-TAVR in Trifecta versus Epic valves.

## Key findings

- ViV-TAVR into Trifecta valves showed a lower rate of the primary composite outcome (6.1% vs. 20%) compared to Epic valves.
- Trifecta patients had a lower risk of patient-prosthesis mismatch compared to Epic patients.
- Survival rates were similar between the two groups at a median follow-up of 365 days.

## Abstract

Little is known about the clinical and hemodynamic outcome of valve‐in‐valve transcatheter aortic valve replacement (ViV‐TAVR) for failed Trifecta surgical aortic bioprotheses.

We aimed to compare outcomes of valve‐in‐valve transcatheter aortic valve replacement (ViV‐TAVR into failed TrifectaTM vs. ViV‐TAVR into a standard aortic bioprosthetic valve with internally mounted leaflets (EpicTM, Abbott, Minneapolis, MN).

Data of consecutive patients who underwent ViV‐TAVR into either failed TrifectaTM or EpicTM bioprostheses between October 2015 and June 2020 were retrospectively collected within the International Trifecta and Epic Valve‐in‐Valve Registry, and analyzed for a primary composite outcome of 30‐day mortality and/or coronary obstruction (CO), defined as: (1) CO resulting in myocardial infarction and/or cardiogenic shock, or (2) CO requiring emergent coronary intervention.

A total of 76 patients (49 Trifecta, 27 Epic) with a median age of 80 years (interquartile range [IQR] 75.0; 82.0]) and a median Society of Thoracic Surgeons‐score of 5.4 (IQR 4.0; 9.8) were identified. Coronary protection techniques were more frequently performed in Trifecta than Epic patients (29.6% vs. 0%, p = 0.01). The primary composite outcome was observed in three Trifecta versus five Epic cases (6.1% vs. 20%, p = 0.1), which included one case of CO following ViV‐TAVR into Epic requiring stenting. Increased rates of patient‐prosthesis mismatch (PPM) following valve‐in‐Epic were found (41.7% vs. 75%, p = 0.08). Survival at a median of 365 days was 86.2% and did not differ between groups (log‐rank p = 0.37).

Compared to a stented prosthesis without increased risk of CO, ViV‐TAVR into Trifecta prostheses can be performed with low risk of CO and acceptable short‐term clinical outcomes. As the rate of post‐ViV PPM is substantial for both prostheses, careful patient selection is warranted. (NCT05389631).