VARC-3 defined outcome of valve-in-valve transcatheter aortic valve implantation in stentless compared with stented aortic bioprostheses

Jean-Honoré Steul; Mohamed Abdel-Wahab; Tomasz Stankowski; Stephan Haussig; Felix J Woitek; Tomasz Gasior; Lisa Crusius; Luise Knorr; Felicitas V Müller; Dirk Fritzsche; Philipp Kiefer; Utz Kappert; David Holzhey; Axel Linke; Norman Mangner

doi:10.1007/s00392-023-02347-5

VARC-3 defined outcome of valve-in-valve transcatheter aortic valve implantation in stentless compared with stented aortic bioprostheses

Clin Res Cardiol. 2023 Dec 11. doi: 10.1007/s00392-023-02347-5. Online ahead of print.

Authors

Affiliations

¹ Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany.
² Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
³ Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany.
⁴ Boehringer Ingelheim International GmbH, Ingelheim, Germany.
⁵ Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
⁶ Department of Cardiac Surgery, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany.
⁷ Department of Cardiac Surgery, Helios University Hospital Wuppertal, Wuppertal, Germany.
⁸ Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany. norman.mangner@tu-dresden.de.

PMID: 38078955
DOI: 10.1007/s00392-023-02347-5

Abstract

Background: Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is a viable alternative to redo surgery in selected patients with bioprosthetic valve dysfunction. Most ViV-TAVI procedures have been performed in stented bioprosthetic valves (ST); stentless bioprostheses (SL) lack fluoroscopic markers and could be more challenging for ViV-TAVI. Data on more recent patients applying Valve Academic Research Consortium (VARC)-3 defined outcomes are scarce. We compared patient characteristics, procedural outcomes, and 5-year mortality of patients with SL versus ST aortic bioprosthetic valve failure undergoing ViV-TAVI.

Methods: Patients undergoing ViV-TAVI between 2007 and 2022 (52.5% of cases after 2015) at 3 German centers were included in this analysis. The co-primary outcome measures were technical success, device success, and early safety defined by VARC-3. Mortality was assessed up to 5 years.

Results: Overall, 43 (11.8%) SL and 313 (88.2%) ST ViV-TAVI were included. Patients were comparable with regard to age, sex, clinically relevant baseline comorbidities, and surgical risk. Technical success (SL: 83.7% versus ST: 79.9%, p = 0.552), device success (SL: 67.4% versus ST: 54.3%, p = 0.105), and early safety (SL: 74.4% versus ST: 66.5%, p = 0.296) were comparable between groups. The 30-day mortality (SL: 7.0% versus ST: 2.6%, p = 0.136) and 5-year mortality rates (SL: 23.3% versus ST: 24.6%, p = 0.874) were not significantly different between groups.

Conclusion: SL and ST ViV-TAVI led to comparable short-term outcomes according to VARC-3- defined endpoints and similar mortality rates up to 5 years of follow-up. VARC-3 defined technical success, device success, and early safety as well as 5-year all-cause mortality in patients undergoing valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) into stentless (SL) compared with stented (ST) failed aortic bioprostheses.

Keywords: Stented bioprosthesis; Stentless bioprosthesis; Transcatheter aortic valve implantation; VARC-3; Valve-in-valve.