Longterm outcome of bail-out ViV-TAVI in the same procedure

Isabel Horn (Bad Oeynhausen)1, H. Omran (Bad Oeynhausen)2, S. Bleiziffer (Bad Oeynhausen)3, S. Scholtz (Bad Oeynhausen)4, V. Rudolph (Bad Oeynhausen)2, K. Friedrichs (Bad Oeynhausen)4, C. Piper (Bad Oeynhausen)2, T. K. Rudolph (Bad Oeynhausen)2

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



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).



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.



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).



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.


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