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    Long-term outcomes after transcatheter aortic valve implantation in failed bioprosthetic valves

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    Author
    Bleiziffer, Sabine
    Simonato, Matheus
    Webb, John G
    Rodés-Cabau, Josep
    Pibarot, Philippe
    Kornowski, Ran
    Windecker, Stephan
    Erlebach, Magdalena
    Duncan, Alison
    Seiffert, Moritz
    Unbehaun, Axel
    Frerker, Christian
    Conzelmann, Lars
    Wijeysundera, Harindra
    Kim, Won-Keun
    Montorfano, Matteo
    Latib, Azeem
    Tchetche, Didier
    Allali, Abdelhakim
    Abdel-Wahab, Mohamed
    Orvin, Katia
    Stortecky, Stefan
    Nissen, Henrik
    Holzamer, Andreas
    Urena, Marina
    Testa, Luca
    Agrifoglio, Marco
    Whisenant, Brian
    Sathananthan, Janarthanan
    Napodano, Massimo
    Landi, Antonio
    Fiorina, Claudia
    Zittermann, Armin
    Veulemans, Verena
    Sinning, Jan-Malte
    Saia, Francesco
    Brecker, Stephen
    Presbitero, Patrizia
    De Backer, Ole
    Søndergaard, Lars
    Bruschi, Giuseppe
    Franco, Luis Nombela
    Petronio, Anna Sonia
    Barbanti, Marco
    Cerillo, Alfredo
    Spargias, Konstantinos
    Schofer, Joachim
    Cohen, Mauricio
    Muñoz-Garcia, Antonio
    Finkelstein, Ariel
    Adam, Matti
    Serra, Vicenç
    Teles, Rui Campante
    Champagnac, Didier
    Iadanza, Alessandro
    Chodor, Piotr
    Eggebrecht, Holger
    Welsh, Robert
    Caixeta, Adriano
    Salizzoni, Stefano
    Dager, Antonio
    Auffret, Vincent
    Cheema, Asim
    Ubben, Timm
    Ancona, Marco
    Rudolph, Tanja
    Gummert, Jan
    Tseng, Elaine
    Noble, Stephane
    Bunc, Matjaz
    Roberts, David
    Kass, Malek
    Gupta, Anuj
    Leon, Martin B
    Dvir, Danny
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    Date
    2020-08-01
    Journal
    European Heart Journal
    Publisher
    Oxford University Press
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1093/eurheartj/ehaa544
    Abstract
    AIMS: Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There are 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 1006 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 (CoreValve/Evolut, Medtronic Inc., Minneapolis, MN, USA) (n = 523, 52.0%), Edwards balloon-expandable valves (EBEV, SAPIEN/SAPIEN XT/SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) (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. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020.
    Rights/Terms
    Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
    Keyword
    Aortic valve-in-valve
    Reintervention
    SAPIEN valve
    Severe prosthesis–patient mismatch
    TAVR
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/13558
    ae974a485f413a2113503eed53cd6c53
    10.1093/eurheartj/ehaa544
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