1Herz- und Diabeteszentrum NRW Kardiologie Bad Oeynhausen, Deutschland; 2Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 3Herz- und Diabeteszentrum NRW Klinik für Thorax- und Kardiovaskularchirurgie Bad Oeynhausen, Deutschland; 4Herz- und Diabeteszentrum NRW Klinik für Kardiologie Bad Oeynhausen, Deutschland
Objective:
This study aimed to compare in-hospital and long-term outcomes of patients with bail-out valve-in-valve TAVI due to a primarily failed transcatheter aortic valves procedure (ViV-TAVI) versus a successful transcatheter aortic valve implantation (TAVI).
Methods:
4555 patients undergoing TAVI at our center were retrospectively included from February 2011 to
March 2022. Propensity score matching was performed to adjust the baseline characteristics between the ViV -TAVI (n= 86) and the TAVI (n= 4469) groups. 231 matched (77:154) patients were analyzed.
Primary endpoint was long-term mortality. In-hospital mortality, stroke, acute kidney failure, need for new permanent pacemaker, and duration of intervention were secondary endpoints.
Results:
In 76.7 % of the cases transcatheter valve embolization and migration were the reasons for implanting a second valve in the same procedure. Significant PVL accounted for bail-out ViV TAVI in 23.4 % of the patients.
Regarding baseline characteristics there was no difference regarding age between the ViV-TAVI (81.5 ± 6.1) and the TAVI patients (82.44 ± 4.5). Euroscore II was significantly higher in the VIV-TAVI group (7.3 ± 8.8 vs. 6.0 ± 6.1). The duration of the intervention was significantly longer for the ViV-TAVI group (111.8 min ± 46.0 vs. 71.3 ± 32.8, p < 0.001) and more contrast medium was used (163.8 ml ± 66.1 vs. 104.8 ml ± 39.3, p < 0.001).
ViV-TAVI patients showed higher rates of a new permanent pacemaker implantation (9.1% vs 20.8%) and the postprocedural mean pressure was significantly higher (11.7 mmHg ± 5.6 vs. 10.0 mmHg ± 5.5, p = 0.02). Concerning the events of in-hospital death (6.5% vs 2.5%), acute kidney failure (28.6 % vs 21.4 %) and stroke (3.9% vs. 1.9%) there were no significant differences between the two groups.
After an average follow-up period of 4.9 ± 3.0 years, mortality was significantly higher in the ViV group (54.5 % vs. 39.0 %, p = 0.025).
Conclusion:
The implantation of a second valve during the same procedure as bail-out is a feasible and safe alternative treatment option in patients with failed transcatheter aortic valve procedures. However increased long-term mortality has to be taken into account.