Early and Midterm Clinical and Hemodynamic Outcomes of Transcatheter Valve-in-Valve Implantation: Results From a Multicenter Experience

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• 作者：Augusto D&rsquo ; Onofrio ; MD ; PhD^a ; ^{adonofrio@hotmail.it" class="auth_mail" title="E-mail the corresponding author} ; Erjon Tarja ; MD^a ; Laura Besola ; MD^a ; Giampaolo Luzi ; MD^b ; Marco Agrifoglio ; MD^c ; Marco Aiello ; MD^d ; Davide Gabbieri ; MD^e ; Giuseppe Tarantini ; MD ; PhD^f ; Giulio Rizzoli ; MD^a ; Francesco Musumeci ; MD^b ; Gino Gerosa ; MD^a
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：102
• 期：6
• 页码：1966-1973
• 全文大小：811 K

文摘

Transcatheter valve-in-valve (VIV) implantation is an alternative option in inoperable or high-risk patients with prosthetic valve dysfunction. Aim of this retrospective multicenter study was to evaluate early and midterm clinical and hemodynamic outcomes of patients undergoing aortic (VIV-A) and mitral VIV (VIV-M).

Methods

We analyzed data of 66 procedures performed in 65 patients who underwent VIV procedures in the VIV-A and VIV-M position at 5 Italian institutions from January 2008 to May 2015. VIV-A and VIV-M were 44 (68%) and 22 (32%), respectively; 1 patient underwent combined mitroaortic VIV. Study devices were both balloon-expandable and self-expandable. Outcomes were defined according to the updated Valve Academic Research Consortium definitions.

Results

Overall all-cause 30-day mortality was 6% (4 patients), and it was 4.5% and 9% in VIV-A and VIV-M, respectively (2 patients in each group). Mean follow-up was 14 ± 14 months. Kaplan-Meier survival of the entire cohort at 1, 2, 3, and 4 years was 84.4% ± 4.9%, 80.5% ± 6%, 74.3 ± 8.1%, and 62% ± 13.2%, respectively. Age (hazard ratio: 1.1; 95% confidence interval: 1.0 to 1.3; p = 0.035) and diabetes (hazard ratio: 7.2, 95% confidence interval: 2.1 to 23.7; p = 0.001) were identified as independent predictors of mortality. Degenerated surgical aortic prostheses with an internal diameter (ID) less than 20 mm had significantly higher gradients if compared to prostheses with ID 21 to 23 mm and greater than 23 mm. After VIV-A, a severe stenosis (mean gradient greater than 35 mm Hg) was detected in 3 (6.8%) cases, all with ID less than 20 mm.

Conclusions

VIV provides good early and midterm results in high-risk or inoperable patients with mitral or aortic bioprosthesis dysfunction. Age and diabetes are independently associated with mortality. Size of bioprosthesis ID has a significant impact on postoperative gradients.