Paukovitsch Michael, Dilaver Bartu, Felbel Dominik, Krohn-Grimberghe Marvin, Buckert Dominik, Moerike Johannes, Schneider Leonhard Moritz, Liewald Christian, Rottbauer Wolfgang, Gonska Birgid
Department of Cardiology, Ulm University Heart Center, Ulm, Germany.
Department of Cardiothoracic and Vascular Surgery, Ulm University Heart Center, Ulm, Germany.
Front Cardiovasc Med. 2025 Apr 22;12:1465409. doi: 10.3389/fcvm.2025.1465409. eCollection 2025.
Despite the lack of randomized-controlled trials in patients with failed bioprosthetic valves, valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is increasingly used.
Outcomes of consecutive patients treated with ViV-TAVR ( = 100) at our tertiary heart center between 2014 and 2022 were compared to TAVR ( = 2216) in native valves.
Patients median age was 78.5 years (IQR 70.0-84.0) in ViV-TAVR compared to 81.0 (IQR 77.0-85.0) in patients with native aortic stenosis ( < 0.01) with a similar percentage of females in both groups (42% vs. 49.3%, = 0.18). The median Society of Thoracic Surgeons score for mortality was significantly higher in patients undergoing ViV-TAVR [5.1% {IQR 2.6%-8.6%} vs. 3.8% {IQR 2.4%-6.3%}, < 0.01]. ViV-TAVR was performed in degenerated surgical bioprostheses in 88% and in degenerated transcatheter bioprostheses in 12%. Stenosis was the main mechanism of bioprosthetic valve failure (70%), whereas severe regurgitation was the leading cause in 30%. The overall rate of device success amounted to 66% in ViV-TAVR, compared to 96.1% in TAVR ( < 0.01) and ViV-TAVR was independently associated with reduced device success (OR: 0.07, 95%CI: 0.045-0.12, < 0.01) in multivariate regression. While ViV-TAVR decreased peak and mean gradients significantly, in 31% of patients elevated mean gradients (≥20 mmHg) were observed at discharge. Small native prosthesis diameter (<20 mm) was the strongest predictor (OR 3.8, 95%CI: 1.5-9.2, = 0.01) independently associated with elevated gradients after ViV-TAVR.
ViV-TAVR for treatment of degenerated bioprostheses improves aortic valve function. However, device success is lower compared to TAVR in native aortic valve disease, mainly due to elevated postprocedural mean gradients, especially in small bioprostheses.
尽管在生物瓣功能障碍患者中缺乏随机对照试验，但瓣中瓣经导管主动脉瓣置换术（ViV-TAVR）的应用越来越广泛。
将2014年至2022年期间在我们的三级心脏中心接受ViV-TAVR治疗的连续患者（n = 100）的结果与初次主动脉瓣置换术（TAVR，n = 2216）的结果进行比较。
ViV-TAVR组患者的中位年龄为78.5岁（四分位间距70.0 - 84.0），而初次主动脉瓣狭窄患者的中位年龄为81.0岁（四分位间距77.0 -
85.0）（P < 0.01），两组女性比例相似（42%对49.3%，P = 0.18）。接受ViV-TAVR治疗的患者胸外科医师协会死亡率评分中位数显著更高[5.1%{四分位间距2.6% - 8.6%}对3.8%{四分位间距2.4% - 6.3%}，P < 0.01]。88%的ViV-TAVR手术是在退化的外科生物瓣中进行的，12%是在退化的经导管生物瓣中进行的。狭窄是生物瓣功能障碍的主要机制（70%），而严重反流是30%的主要原因。ViV-TAVR的器械成功率总体为66%，而TAVR为96.1%（P < 0.01），在多因素回归分析中，ViV-TAVR与器械成功率降低独立相关（比值比：0.07，95%置信区间：0.045 - 0.12，P < 0.01）。虽然ViV-TAVR显著降低了峰值和平均梯度，但在31%的患者出院时观察到平均梯度升高（≥20 mmHg）。较小的初次人工瓣膜直径（<20 mm）是与ViV-TAVR术后梯度升高独立相关的最强预测因素（比值比3.8，95%置信区间：1.5 - 9.2，P = 0.01）。
ViV-TAVR治疗退化生物瓣可改善主动脉瓣功能。然而，与初次主动脉瓣疾病的TAVR相比，器械成功率较低，主要是由于术后平均梯度升高，尤其是在小生物瓣中。
