Valve-in-Valve-in-Valve Transcatheter Aortic Valve Replacement in Practice: Largest Single Center Experience

Authors

David Rayan, Advocate Health - MidwestFollow
Suhail Allaqaband, Advocate Health - MidwestFollow
Muhammad Fuad Jan, Advocate Health - MidwestFollow
Kirsten Tunink, Advocate Health - MidwestFollow
Viviana Zlochiver, Advocate Health - MidwestFollow
Eric Weiss, Advocate Health - MidwestFollow
John Crouch, Advocate Health - MidwestFollow
David Boulware, Advocate Health - MidwestFollow
Renuka Jain, Advocate Health - MidwestFollow
Tanvir Bajwa, Advocate Health - MidwestFollow

Recommended Citation

Rayan D, Allaqaband S, Jan MF, et al. Valve-in-Valve-in-Valve Transcatheter Aortic Valve Replacement in Practice: Largest Single Center Experience. Presented at the Transcatheter Cardiovascular Therapeutics (TCT) Conference; October 27-30, 2024; Washington D.C.

Affiliations

Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers

Presentation Notes

Presented at the Transcatheter Cardiovascular Therapeutics (TCT) Conference; October 27-30, 2024; Washington D.C.

Abstract

Background: Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are both beset with structural valve degeneration several years after the procedure. As valve-in-valve TAVR expands into the low-risk and intermediate-risk inpatient population, the number of patients requiring future reintervention is expected to be high. Limited data are available on reintervention of failed bioprosthetic valve-in-valve treated with valve-in-valve-in-valve (ViViV). We aimed to analyze clinical characteristics and procedural and clinical outcomes of SAVR-in-TAVR-in-TAVR.

Methods: Data were collected on 3,742 TAVRs performed at our center from January 1, 2012, to January 31, 2024; a total of 7 patients were identified as having undergone a ViViV in the form of SAVR-in-TAVR-in-TAVR. The primary endpoint of this study was procedural success rate, defined as postprocedural correct positioning of the valve and absence of procedural complications such as coronary artery obstruction and/or valve displacement. Secondary endpoints of this study were procedural major adverse cardiovascular and cerebrovascular events (MACCE), residual aortic valve gradient post-procedure, and 30-day and 1-year survival.

Results: Median age was 77 years at the time of ViViV. Median time between SAVR and first TAVR was 11.6 years. Median time between TAVR and re-do TAVR was 38.5 months. There were 4 males and 3 females. Four of the 7 patients were in NYHA functional class III or IV. Procedural success was 100%. Median aortic valve mean gradient post-procedure was 16.5 mmHg. There were no procedural MACCE events. At 30 days and 1 year, survival was 100% for both.

Conclusions: In this small cohort of 7 patients who underwent a ViViV, we found very favorable results with acceptable post-procedural mean gradient in addition to 100% survival at both 30 days and 1 year.

Type

Poster