Outcomes Of Valve-invalve Versus Redo Aortic Valve Replacement For Degenerated Externally Mounted Aortic Bioprostheses
Philipp Kiefer1, Philine von Wilcke1, Alexandro Hoyer1, Thilo Noack1, Thomas Schröter1, Norman Mangner1, Axel Linke2, Joerg Seeburger1, David Holzhey1, Michael Borger1.
1Heart Center Leipzig, Leipzig, Germany, 2Heart Center Dresden, Dresden, Germany.
Background: Degenerated externally mounted bioprostheses (EMB) in small aortic roots are attributed to have major complications after transcatheter Valve-in-Valve (ViV) procedures. We sought to compare outcomes for ViV procedures compared to redo aortic valve replacement (RAVR) for degenerated EMB. Methods: Between 2011 and 2017, 97 patients with dysfunctional EMB were treated whether for ViV or RAVR. 48 patients were excluded due to active endocarditis. Remaining 49 patients had a medical history of aortic valve replacement with Mitroflow (n=21, Sorin Group, Milan, Italy) and Trifecta (n=28, St. Jude Medical, St. Paul, MN). Multidisciplinary team decided for ViV procedure and RAVR in 29 patients (58%) and 20 patients (42%), respectively. The initially implanted EMB size was equal for both groups, 22.6±2.1 mm (ViV) vs 22.75±2.2 mm (RAVR). The predominant transcatheter valve for ViV was Corevalve (n=26, 90%; Medtronic Inc., MN,) and the Sapien 3 (n=3, 10%, Edwards Lifesciences, Irvine, CA,), all used transfemorally. Perioperative results, hemodynamic assessment and outcomes have been analized. Results: For ViV versus RAVR treated patients, the mean age was 78.6±5.0 vs 71.6±8.4 (p<0.001) with a mean logEuroScore of 31.5±13.8 vs 26.8±22.2 (p=0.31). Procedural success was seen in all of the cases (n=49; 100%). Perioperative results for ViV vs RAVR were comparable, besides: 1: need for blood transfusion (>2 RBC): n=1 (3.4%) vs n=9 (45%) (p<0.001), 2: new onset for cardiac arrythmia, n=1 (3.4%) vs n=10 (50%) (p<0,001), 3: Respiratory failure, n=2 (6.9%) vs n=8 (40%) (p=0.01), 4: Pmean postop (Echocardiography), 16.8±8.3 mmHg (but Peak-to-Peak intraop: 9±7mmHg) vs 10.8±5.2 mmHg (p=0.012). One patient in the ViV group required reoperation (RAVR) after 4 days due to late coronary obstruction. 30 day mortality was equal with n=3 (10.3%) vs n=3 (15%). No significant differences for longterm survival in both groups so far. Conclusion: The two treatment options for degenerated EMB showed almost equal results. However, patient selection for either treatment group should still be evaluated individally by a Heart Team, that consists of specialists that are skilled with both treatment options.
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