Transcatheter Treatment of Degenerated Bioprosthetic Valves: Patients Characteristics, Procedural Details and Outcomes - A Multicenter Israeli Registry - The 64th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 25-26 April 2017

Uri Landes ¹ Amit Segev ² Israel Barbash ² Yaron Almagor ³ Haim Danenberg ⁴ Ronen Jaffe ⁵ Ram Sharony ⁶ Katia Orvin ¹ Amos Levi ¹ Abid Assali ¹ Hana Vaknin-Assa ¹ Nader Khader ⁵ Ashraf Hamdan ¹ Yaron Shapira ¹ Ehud Raanani ² Alexander Sagie ¹ Victor Guetta ² Ran Kornowski ¹

¹Department of Cardiology, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University
²Leviev Heart Center, Sheba Medical Center
³Department of Cardiology, Shaare Zedek Medical Center
⁴Department of Cardiology, Hadassah Medical Center
⁵Department of Cardiology, Carmel Medical Center
⁶Department of Cardiothoracic Surgery, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University

Background:
Transcatheter Valve-in-Valve implantation (ViV) is a less invasive approach to treat patients with bioprosthetic valve deterioration at high risk for redo-surgery. This is the largest registry reporting on ViV experience in Israel.

Methods:
A datasheet was circulated to multiple Israeli centers involved in ViV. Data from participating centers were collected, analyzed and reported in-line with VARC-2 recommendations.

Results:
Between March-2010 and Nov-2016, along with a linear growth in procedural volume, a total of 132 patients underwent ViV in the 5 partaking centers: age 77 [SD, 13] years; 38% men; median Society-of-Thoracic-Surgeons (STS) score 6.1 [IQR, 4.1; 10.4] %. Throughout the years there was a shift to treat patients at lower STS-score (9.7% to 7.1%, p<0.01). Follow-up continued up-to 6.5 years [median 2.5 (IQR, 1.1; 3.8) years]. Procedures were performed in the aortic (70%) [mean age 77±12 years, STS-score: 7.8±5.4%], mitral (23%) [mean age 76±12 years, STS-score: 9.5±6.5%], tricuspid (5%) [mean age 69±5.9 years, STS-score: 3.8±1.2%], and combined (2%) positions. Aortic-VIV were performed via the trans-femoral, trans-apical and trans-axillary routes in 92.5%, 2.5% and 5%; respectively, and using self-expandable (94%) or balloon-expandable (6%) devices. Mitral-VIV were performed via the trans-apical route (97.5%) and using balloon-expandable (SXT, 93.5%; S3, 6.5%) devices. The composite end-point of device success rate was 97%, and 30-days stroke rate was 0.9%. Baseline NYHA functional-class was III/IV in most (87%) patients, enhanced to I/II in the majority (91%, at 1-month), and kept well stable in long-term follow-up. Survival rates for all-VIV patients was: 94.5% (30-days), 92%% (1-year), and 75% (3-years).

Conclusions:
The ViV intervention in 5 Israeli TAVI centers is being used to treat a wide range of degenerated surgical valves in different positions. It is safe, effective and expanding. The implications on surgical vs. ViV strategy as optimal management of patients at lower-risk needs further investigation.