Aims: Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There is no data on long-term outcomes after aortic ViV. Our aim was to perform a large-scale assessment of long-term survival and reintervention after aortic ViV.
Methods and Results: A total of 1,006 aortic ViV procedures performed more than 5 years ago (mean age 77.7±9.7 years; 58.8% male; median STS-PROM score 7.3% [4.2-12.0]) were included in the analysis. Patients were treated with Medtronic self-expandable valves (MSEV, CoreValve/Evolut, Medtronic Inc.) (n=523, 52.0%), Edwards balloon-expandable valves (EBEV, SAPIEN/SAPIEN XT/SAPIEN 3, Edwards Lifesciences) (n=435, 43.2%) and other devices (n=48, 4.8%). Survival was lower at 8 years in patients with small failed bioprostheses (internal diameter [ID] ? 20 mm) compared with those with large failed bioprostheses (ID > 20 mm) (33.2% vs. 40.5%, p=0.01). Independent correlates for mortality included smaller failed bioprosthetic valves (hazard ratio [HR] 1.07 [95% confidence interval {CI} 1.02-1.13]), age (HR 1.21 [95% CI 1.01-1.45]) and non-transfemoral access (HR 1.43 [95% CI 1.11-1.84]). There were 40 reinterventions after ViV. Independent correlates for all-cause reintervention included pre-existing severe prosthesis-patient mismatch (subhazard ratio [SHR] 4.34 [95% CI 1.31-14.39]), device malposition (SHR 3.75 [95% CI 1.36-10.35]), EBEV (SHR 3.34 [95% CI 1.26-8.85]), and age (SHR 0.59 [95% CI 0.44-0.78]).
Conclusions: The size of the original failed valve may influence long-term mortality and the type of the transcatheter valve may influence the need for reintervention after aortic ViV.
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