Department of Research, Baylor Scott and White Research Institute Plano, Texas.
Research Department, The Heart Hospital Baylor, Plano, Texas.
Am J Cardiol. 2024 Nov 1;230:50-57. doi: 10.1016/j.amjcard.2024.08.001. Epub 2024 Aug 6.
Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has been associated with favorable outcomes in patients with degenerated stentless bioprosthesis. However, whether the outcomes after ViV TAVR for failed stentless bioprosthesis differ between balloon-expandable valves (BEVs) and self-expanding valves (SEVs) remains unknown. Therefore, we retrospectively analyzed 59 consecutive patients who underwent ViV TAVR for failed stentless bioprsothesis with BEVs (n = 42) versus SEVs (n = 17) in a single-health care system between 2013 and 2022. Overall, the mean age was 70.8 years and 74.6% were men. The mean transcatheter valve size was 26.3 ± 2.2 mm for BEVs and 26.4 ± 4 mm for SEVs (p = 0.93). The mean Society of Thoracic Surgeons score was 6.0 ± 3.6 for BEVs and 7.5 ± 5.5 for SEVs (p = 0.22). Compared with patients who received BEVs, those who received SEVs had higher rates of device malposition (2.4% vs 23.5%, p <0.01), postdeployment balloon dilation (11.9% vs 35.5%, p = 0.04) and need for a second transcatheter device (2.4% vs 35.5%, p <0.01). However, both groups showed similar improvement in aortic valve function at 30-day and 1-year follow-up (incidence of 1-year severe patient-prosthesis mismatch in BEVs: 17.6% vs 14.3% in SEVs, p = 0.78). The 1- and 3-year mortality did not differ between BEVs and SEVs (11.9% vs 11.8% and 25% vs 30%, respectively, Log rank p = 0.9). In conclusion, performing ViV TAVR for failed stentless bioprsothesis is technically challenging, especially when using SEVs; however, satisfactory positioning is possible in most cases, with excellent hemodynamic and clinical outcomes with BEVs and SEVs.
经导管主动脉瓣置换术（TAVR）中的经导管瓣中瓣（ViV）技术已被证明在退行性生物瓣支架瓣患者中具有良好的效果。然而，在失败的生物瓣支架瓣患者中，使用球扩瓣（BEV）和自膨瓣（SEV）进行 ViV TAVR 的结果是否存在差异仍不清楚。因此，我们回顾性分析了 2013 年至 2022 年间，在单一医疗系统中，59 例连续接受 ViV TAVR 治疗失败的生物瓣支架瓣患者，其中 BEV 组 42 例，SEV 组 17 例。总体而言，患者平均年龄为 70.8 岁，74.6%为男性。BEV 组和 SEV 组的经导管瓣膜平均尺寸分别为 26.3±2.2mm 和 26.4±4mm（p=0.93）。BEV 组和 SEV 组的胸外科医生协会评分分别为 6.0±3.6 和 7.5±5.5（p=0.22）。与接受 BEV 的患者相比，接受 SEV 的患者器械位置不良的发生率更高（2.4% vs. 23.5%，p<0.01），后扩张球囊扩张的发生率更高（11.9% vs. 35.5%，p=0.04），需要使用第二种经导管器械的发生率更高（2.4% vs. 35.5%，p<0.01）。然而，两组在 30 天和 1 年随访时主动脉瓣功能均有相似的改善（BEV 组的 1 年重度患者-瓣匹配不良发生率为 17.6%，SEV 组为 14.3%，p=0.78）。BEV 组和 SEV 组的 1 年和 3 年死亡率无差异（分别为 11.9%、11.8%和 25%、30%，Log rank p=0.9）。总之，对于失败的生物瓣支架瓣患者，行 ViV TAVR 技术具有一定挑战性，尤其是使用 SEV 时；然而，在大多数情况下可以实现满意的定位，使用 BEV 和 SEV 均具有出色的血流动力学和临床效果。
