Transcatheter Aortic Valve Replacement for a Degenerated Transcatheter Valve-A Single Center Experience

Background The transcatheter valve-in-valve treatment (TAV-in-TAV) of degenerated transcatheter aortic valves is becoming more relevant, as the use of transcatheter aortic valve replacement (TAVR) increases. We report our experience with TAV-in-TAV in patients with a degenerated transcatheter heart valve (THV). Methods We retrospectively analyzed prospectively collected data from our designated TAVR database. Intraprocedural and intrahospital outcomes were reported. Results Ten patients out of a total of 3,144 TAVR implantations since 2007 presented with a degenerated THV, among those six with an Edwards Sapien XT (Edwards Lifesciences, Irvine, California, United States) valve, treated with a Medtronic Evolut R (Medtronic, Dublin, Ireland) valve. Four patients had severe stenosis, one pure insufficiency, and five combined stenosis and insufficiency. Average time between initial implantation and re-intervention was 6.81.3 years. The mean preoperative maximum and mean gradients were 54.2 +/- 14.8mm Hg and 31.6 +/- 9.9mm Hg, respectively. Nine patients underwent transfemoral and one patient underwent transaortic TAV-in-TAV. Mean procedural time was 86.2 +/- 51.5minutes. Post-implantation, the maximum and mean gradients decreased to 18 +/- 6.9mm Hg and 8.4 +/- 3.2mm Hg (16 +/- 8mm Hg and 6.4 +/- 1.7mm Hg in the Evolut-in-Sapien subgroup), respectively. The valve area increased from 0.98 +/- 0.28mm Hg to 1.72 +/- 0.32mm Hg (0.8 +/- 0.07mm Hg to 1.9 +/- 0.16mm Hg in the Evolut-in-Sapien subgroup). Two patients experienced a vascular complication. No further Valve Academic Research Consortium-2 criteria complications occurred during hospitalization. Conclusion TAV-in-TAV resulted in low procedural and peri-procedural complication rates. In particular, the usage of a supra-annular valve resulted in excellent hemodynamic results. Larger studies are required to validate this observational data and to establish a protocol for this procedure.