# Changes in patient characteristics and procedural measures over a 10-year period in aortic valve-in-valve procedures for degenerated surgical bioprostheses

## TL;DR

This study tracks how patient traits and procedures for aortic valve-in-valve treatments changed over 10 years, showing improved techniques and outcomes.

## Contribution

The study provides a 10-year analysis of procedural and patient changes in aortic valve-in-valve procedures, highlighting technical advancements and stable early outcomes.

## Key findings

- Patients showed lower EuroSCORE II and symptomatic burden over time, with stable age.
- Technical advancements included increased transfemoral access and BASILICA procedures, with a trend toward valve fracturing.
- Early outcomes remained favorable with consistently low 30-day mortality and high device success rates.

## Abstract

This single-center study investigates changes in patient characteristics and procedural measures over a period of 10 years in aortic valve-in-valve procedures for treatment of degenerated surgical bioprostheses. Baseline, procedural, early outcome, and echocardiographic parameters were retrospectively compared between three time periods (period 1: 2013–2016, period 2: 2017–2020, and period 3: 2021–2023). Main changes in characteristics, technical improvements, and early outcomes in patients are illustrated.Infographic summarizing a 10-year single-center study of 256 transcatheter aortic valve-in-valve (TAVI ViV) procedures for degenerated surgical bioprostheses across three time periods: 2013–2016, 2017–2020, and 2021–2023. Over time, patients showed lower EuroSCORE II and symptomatic burden with stable age. Technical advancements included more BASILICA procedures, increased transfemoral access,
and a trend toward valve fracturing. Use of cerebral protection devices decreased significantly.
Early outcomes remained favorable, with consistently low 30-day mortality, stroke, and myocardial
infarction rates, and high device success across all time periods.

This single-center study investigates changes in patient characteristics and procedural measures over a period of 10 years in aortic valve-in-valve procedures for treatment of degenerated surgical bioprostheses. Baseline, procedural, early outcome, and echocardiographic parameters were retrospectively compared between three time periods (period 1: 2013–2016, period 2: 2017–2020, and period 3: 2021–2023). Main changes in characteristics, technical improvements, and early outcomes in patients are illustrated.

Aortic valve-in-valve procedures for treatment of degenerated surgical bioprostheses are an established therapy. In this study, we evaluated how the risk profiles, procedural approaches, and early outcomes for patients in these procedures changed over a period of 10 years.

Baseline, procedural, early outcome, and echocardiographic parameters were retrospectively compared between three time periods (period 1: 2013–2016, period 2: 2017–2020, and period 3: 2021–2023).

Between 2013 and 2023, a total of 256 patients underwent valve-in-valve implantation in degenerated aortic bioprostheses at our center with a steady increase of patient numbers. The median age of the patients was 78.0 (interquartile range 72.2–82.4) years and remained unchanged over time. EuroSCORE II presented lower risk profiles in later periods (p = 0.001). Access proportions changed with transfemoral access in 100% of patients in period 3 (p < 0.001). Rates of BASILICA procedures (0% vs. 17.5% vs. 19.4%; p < 0.001) and valve fracturing steadily increased (0% vs. 6.3% vs. 7.8%; p = 0.058). Cerebral protection device use presented a distinct decline to 18.4% in period 3 (p < 0.001). Procedure time and length of intensive care unit stay decreased significantly over time. Early outcome parameters such as rates of permanent pacemaker implantation, bleeding, acute kidney injury, disabling stroke (0.0% vs. 1.3% vs. 1.0%; p = 0.653), and device success (91.8% vs. 92.5% vs. 98.1%; p = 0.123) showed no significant changes over time. The rate of 30-day mortality decreased to 0% in period 3 (p = 0.069).

Advancements in technical approaches have expanded eligibility for patients previously considered unsuitable for aortic valve-in-valve procedures. In this study, it was found that early outcomes for patients were excellent, with improvement over time, highlighting the clinical efficacy and safety of the procedures.