Intermediate-Term Follow-up of Patients Treated using the Valve-in-Valve Technique for the Treatment of Aortic, Mitral and Tricuspid Structural Valve Deterioration

Background: Percutaneous treatment of structural valve deterioration (SVD) in the aortic, mitral and tricuspid position is an established and evolving alternative to re-do surgery. Herein we report our intermediate-term results of patients with SVD in the aortic, mitral and tricuspid valve position, in a wide range of patients with different and complex valve pathologies.

Methods: A total of 119 consecutive patients with symptomatic SVD treated using the valve-in-valve (VinV) technique treated from March 2010 to November 2018, were included in this analysis.

Results: The VinV in the aortic position was performed in 66 patients (mean age 78.7 ±7.9; mean STS score 6.9 ±4.7). The self-expandable and balloon-expandable devices were used in 53 (80%) and 13 (19.7%) patients; respectively. Procedures were performed via the trans-femoral , trans-subclavian and trans-apical route in 60 (91%), 4 (6%) and 2 (3%) of cases; respectively. Survival rates at 4 years follow up were 65.2%.

The VinV procedure in the mitral position was performed in 42 patients (66.6% female), mean age 75.8 ±8.4, mean STS 8.8 ±3.2. All procedures were performed using the balloon-expandable device. The trans-apical route was used in all procedures until the year 2016 (16 patients). Since 2017 the transseptal route was used in all patients (N=26). Mean hospital stay 4.7 ±1.6 days. Survival rates at 3 years follow-up were 76.2%.

A total of 12 patients (83.3% female) underwent tricuspid VinV. Mean age 64.4 ±10.6 years. Mean STS 6.2±3.1. The composite end point of device success was achieved in all patients. Mean hospital stay 3.1 ±1.3 days. Survival rates at 2 years follow up were 87.5%.

Conclusion: The valve-in-valve technique for the treatment of a wide range of bioprosthetic valve deterioration modes of failure in different valve positions is associated with favorable clinical outcomes at intermediate and long term follow-up.