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J Am Coll Cardiol. 2019 Jun 4;73(21):2647-2655. doi: 10.1016/j.jacc.2019.03.483.

3-Year Outcomes After Valve-in-Valve Transcatheter Aortic Valve Replacement for Degenerated Bioprostheses: The PARTNER 2 Registry.

Author information

1
St. Paul's Hospital, Vancouver, British Columbia, Canada. Electronic address: johngraydonwebb@gmail.com.
2
St. Paul's Hospital, Vancouver, British Columbia, Canada.
3
Columbia University Medical Center, New York, New York.
4
Cardiovascular Research Foundation, New York, New York.
5
University of Washington, Seattle, Washington.
6
University of Pennsylvania, Philadelphia, Pennsylvania.
7
Stanford University, Stanford, California.
8
Laval University, Quebec, Quebec, Canada.
9
Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
10
Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York.
11
Baylor Scott & White Health, Plano, Texas.

Abstract

BACKGROUND:

Transcatheter aortic valve replacement (TAVR) for degenerated surgical bioprosthetic aortic valves is associated with favorable early outcomes. However, little is known about the durability and longer-term outcomes associated with this therapy.

OBJECTIVES:

The aim of this study was to examine late outcomes after valve-in-valve TAVR.

METHODS:

Patients with symptomatic degeneration of surgical aortic bioprostheses at high risk (≥50% major morbidity or mortality) for reoperative surgery were prospectively enrolled in the multicenter PARTNER (Placement of Aortic Transcatheter Valves) 2 valve-in-valve and continued access registries. Three-year clinical and echocardiographic follow-up was obtained.

RESULTS:

Valve-in-valve procedures were performed in 365 patients. The mean age was 78.9 ± 10.2 years, and the mean Society of Thoracic Surgeons score was 9.1 ± 4.7%. At 3 years, the overall Kaplan-Meier estimate of all-cause mortality was 32.7%. Aortic valve re-replacement was required in 1.9%. Mean transaortic gradient was 35.0 mm Hg at baseline, decreasing to 17.8 mm Hg at 30-day follow-up and 16.6 mm Hg at 3-year follow-up. Baseline effective orifice area was 0.93 cm2, increasing to 1.13 and 1.15 cm2 at 30 days and 3 years, respectively. Moderate to severe aortic regurgitation was reduced from 45.1% at pre-TAVR baseline to 2.5% at 3 years. Importantly, moderate or severe mitral and tricuspid regurgitation also decreased (33.7% vs. 8.6% [p < 0.0001] and 29.7% vs. 18.8% [p = 0.002], respectively). Baseline left ventricular ejection fraction was 50.7%, increasing to 54.7% at 3 years (p < 0.0001), while left ventricular mass index was 136.4 g/m2, decreasing to 109.1 g/m2 at 3 years (p < 0.0001). New York Heart Association functional class improved, with 90.4% in class III or IV at baseline and 14.1% at 3 years (p < 0.0001), and Kansas City Cardiomyopathy Questionnaire overall score increased (43.1 to 73.1; p < 0.0001).

CONCLUSIONS:

At 3-year follow-up, TAVR for bioprosthetic aortic valve failure was associated with favorable survival, sustained improved hemodynamic status, and excellent functional and quality-of-life outcomes. (The PARTNER II Trial: Placement of Aortic Transcatheter Valves II - PARTNER II - Nested Registry 3/Valve-in-Valve [PII NR3/ViV]; NCT03225001).

KEYWORDS:

6-min walk distance; aortic stenosis; mortality; registry; regurgitation

PMID:
31146808
DOI:
10.1016/j.jacc.2019.03.483

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