E-38 | Valve-in-Valve: Single-Center Experience

Surgical aortic valve (SAV) replacement and transcatheter AV (TAV) replacement (TAVR) are both beset with structural valve degeneration several years post procedure. As TAVR expands into the low- and intermediate-risk in-patient population, the number of required reinterventions is expected to be high. Limited data are available on reintervention in failed bioprosthetic aortic valves treated either with TAV-in-TAV or TAV-in-SAV. Data were collected on 241 consecutive valve-in-valve cases (17 TAV-in-TAV, 224 TAV-in-SAV) from Jan. 1, 2012 to Aug. 31, 2022. Principal endpoints were procedural success rate, residual AV gradient post procedure, new permanent pacemaker (PPM) implantation, and survival at 1 and 5 years. Median age was 78 years in TAV-in-SAV and 79.4 years in TAV-in-TAV (p=NS); there was no sex difference. More patients in TAV-in-TAV than TAV-in-SAV were in NYHA Class IV (25% vs 5.7%, p=.04). Procedural success rate was 100% in both groups. Post-procedure AV mean gradient was 17 mmHg in TAV-in-SAV vs 12.5 mmHg in TAV-in-TAV (p=.04). The most frequent indication was severe aortic regurgitation in TAV-in-TAV and severe aortic stenosis in TAV-in-SAV (0.04). Pacemaker implantation was statistically insignificant in the entire cohort, with 5 patients getting a PPM (4 TAV-in-SAV, 1 TAV-in-TAV, p=NS). The 1-year survival rate was higher in TAV-in-SAV than TAV-in-TAV patients (90.1% vs 66.9%, p≤.05). In a cohort of valve-in-valve patients in practice, TAV-in-TAV was less frequent than TAV-in-SAV and TAV-in-TAV patients were sicker, more likely to have aortic regurgitation, and had worse 1-year survival.