Overview of the Valve in Valve Procedure by TAVI into Failed Bioprosthetic Aortic Valves

Introduction: Bioprosthetic valves have limited durability, bests have an expected life-time within 10-15 years. However reoperative surgical risks show high morbidity-mortality risk. Transcatheter aortic valve implantation /TAVI/ within surgically implanted failed bioprosthesis and for failed /transcatheter valves/ TV was proved in the last decade as feasible in selected patients.Opposit to higher risk of mortality-morbidity of conventional surgical procedure. We reviewed the indications, the risks & short term results of the vale-in-valve /VinV/ procedures results in the Global Registry with failed aortic bioprosthesis. Methods: There are stented valves:155,76,7 %; stentless valves:47;23.3% & TAVI bioprosthesis as candidates with sub-, inter-, supra-annular position. Two types of TAVI valves has experienced by the GViVR with Edwards -SapienXT:38,6 % vs. Medtronic-CoreValve:61,4%. />500 patients ; > 50 centres. / Results: Freedom from structural damage were: 70-90% at 10 years & 40-70% at 15 years. Median life-time by the GViVR were 9 years. After the AATS report the predicted risk of procedural mortality with reoperation:11,8 %. Actual with VinV procedure:9,4 %; the 30 days survival:90,6 % ; mean AO Gradient:15,9 mmHg, device malposition:15% & coronary occlusion:3,5%. Second TV:8,4 %; attemted TV retrieval: 8,9%; balloon valvuloplasty:12,4 %; stroke-rate:2%. Small size valves AO Gradient > 20 mmHg:28,4 %; Sapien XT vs. CoreValve in AO-Gradient.:59% vs.20%. Conclusion: VinV seems a feasible procedure in selected patients, but the high incidence of coronary occlusion and malposition are not acceptable. Need immediate improvement in human error correction. Limitation of VinV approaches is in small size TV-s with elevated AO gradients (>20 mmHg). We need time before we can appreciate high quality results of clinical reults of this new option for patients for failed aortic bioprosthesis.