Objective

Transcatheter aortic valve-in-valve implantation (ViV) is a new treatment option for failing bioprostheses (BP) in patients at high surgical risk. However, direct comparative data with standard repeat surgical aortic valve replacement (redo-SAVR) is scarce. We compared outcomes after ViV to conventional redo-SAVR in two European centers with established interventional programs.

Methods

In-hospital databases were retrospectively screened for patients ≥60 years, treated for failingaortic BP’s. Cases of infective endocarditis or combined procedures were excluded. From 2002 through 2015, 130 patients were treated for failure of aortic BP (ViV: n=71, redo-SAVR: n=59). Endpoints were adjudicated according to VARC-2 criteria.

Results

Age and logistic EuroSCORE I, were higher in ViV compared to redo-SAVR (78.6 ±7.5ys vs. 72.9 ±6.6ys, p<0.01; 25.1 ±18.9% vs. 16.8 ±9.3%, p<0.01). Thirty-day mortality was not different with 4.2% and 5.1% (p=1.0). Device success was achieved in 52.1% (ViV) and 91.5% (redo-SAVR, p<0.01). Intensive-care stay was longer after redo-SAVR (p<0.01). Mean transvalvular gradients at discharge were higher post ViV (19.7 ±7.7 vs.12.2 ±5.7mmHg, p<0.01). Survival at 180-days was 91.8% vs. 94.4% (p=0.87).

Conclusion

Despite a higher risk profile in the ViV group, early mortality was not different compared to surgery. Although ViV resulted in elevated transvalvular pressure gradients and therefore a lower rate of formal device success, mortality after 180-days was similar to redo-SAVR. At present, both techniques serve as complementary approaches and allow individualized patient care resulting in excellent outcomes in these elderly patients.