Percutaneous Valve-in-Valve Implantation for the Treatment of Aortic, Mitral and Tricuspid Structural Bioprosthetic Valve Degeneration

Background: Many patients with a failed bioprosthetic valve are at high risk for redo surgery. The percutaneous Valve-in-Valve approach (VIV) is an emerging alternative. We report our VIV experience.

Methods: Outcomes of 54 consecutive patients treated for symptomatic bioprosthetic valve deterioration using VIV at our institution were analyzed and reported according to the Valve Academic Research Consortium 2 definitions.

Results: Follow-up time continued up to 5 years [median 552 (214; 583) days]. The VIV procedure was performed in the aortic position: 38 (70%) patients, mean age 80.5±6.9 years, 20 (55%) females, mean STS score: 7.8±4.8; in the mitral position: 14 (26%) patients, mean age 74.9±13.2 years, 10 (71%) females, mean STS score: 10.6±7.1; in the tricuspid position in 2 (3%) female patients with STS scores of 5 and 3.8. In the aortic-VIV, procedures were performed via the trans-femoral, trans-apical and trans-axillary routes in 33 (87%), 2 (5%) and 3(8%) cases; respectively, with the use of self-expandable and balloon-expandable devices in 34 and 3 cases; respectively. Pre-procedural NYHA functional-class was III/IV in most patients (35, 94%), enhanced to I/II in the majority (25, 83%) at 1-month and preserved stable in long term follow-up. Mitral-VIV procedures were all performed via the trans-apical route and by using balloon-expandable devices. The composite end-point of device success was achieved in all patients. Two VIV implantations in a failed tricuspid bioprosthetic valve were also successfully performed. Survival rates for all VIV patients was 100% at 30 days and 92% at 1-year (e.g. 93% aortic and 90% mitral position). None of the deaths was due to a cardiovascular cause.

Conclusions: This report on one of the worlds’ largest single center VIV-cohort demonstrates that using the VIV technique to treat a wide range of valve failure modes and in different positions is feasible, safe and very effective.