Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Clinical Research in Cardiology
Published in: Clinical Research in Cardiology 1/2019

01-01-2019 | Original Paper

Transcatheter valve-in-valve implantation (VinV-TAVR) for failed surgical aortic bioprosthetic valves

Authors: Bernhard Wernly, Ann-Katrin Zappe, Axel Unbehaun, Jan-Malte Sinning, Christian Jung, Won-Keun Kim, Stephan Fichtlscherer, Michael Lichtenauer, Uta C. Hoppe, Brunilda Alushi, Frederik Beckhoff, Charlotte Wewetzer, Marcus Franz, Daniel Kretzschmar, Eliano Navarese, Ulf Landmesser, Volkmar Falk, Alexander Lauten

Published in: Clinical Research in Cardiology | Issue 1/2019

Login to get access

Abstract

Objective

We sought to investigate the procedural and hemodynamic outcome after valve-in-valve transcatheter aortic valve replacement (VinV-TAVR) for different surgical (SBV) and transcatheter (TAVR) bioprosthetic valves.

Methods and results

223 patients (76 ± 11years, STS-Score 8.3 ± 10.1) suffering from SBV failure treated with VinV-TAVR were enrolled at 6 centers across Germany. At time of the intervention, the majority of patients were in NYHA-class ≥ III (88%, n = 180). Failure mode of the SBVs was either stenosis, regurgitation (AR) or a combination of both in 85 (38%), 76 (34%) and 62 (28%) patients, respectively. 138 (62%) patients were treated with first generation TAVR valves (Edwards Sapien XT or CoreValve). Second generation valves were implanted in 85 (38%) patients (Sapien 3, Medtronic CoreValve Evolut, SJM-Portico, JenaValve). VinV-TAVR was associated with high procedural success rate, conversion to surgery was necessary in 3 (2%) patients. After VinV-TAVR procedure, 4 (2%) patients suffered from ≥ moderate AR. In 6 (3%) patients a second valve was implanted due to mispositioning of the first valve and subsequent severe paravalvular AR. Coronary obstruction was observed in 4 (2%) patients. Major bleeding and cerebrovascular complications (according to VARC) were reported in 3 (1%) and 4 (2%) patients at 30 days. Post-interventionally, 44/178 (25%) patients evidenced a mean pressure gradient (mPG) ≥ 20 mmHg. Residual stenosis was not associated with increased mortality (HR 0.39; 95% CI 0.13–1.22; p = 0.11).

Conclusion

In VinV-TAVR for SBV-failure is a safe procedure resulting in hemodynamic improvement in the majority of patients. Residual stenosis is a common finding which can be observed in 1/4 of patients undergoing VinV-TAVR. However, this condition is not associated with increased 1-year-mortality.
Literature
1.
Doenst T, Essa Y, Jacoub K, Moschovas A, Gonzalez-Lopez D, Kirov H, Diab M, Bargenda S, Faerber G (2017) Cardiac surgery 2016 reviewed. Clin Res Cardiol 106(11):851–867CrossRefPubMed
2.
Dvir D, Bourguignon T, Otto CM, Hahn RT, Rosenhek R, Webb JG, Treede H, Sarano ME, Feldman T, Wijeysundera HC et al (2018) Standardized definition of structural valve degeneration for surgical and transcatheter bioprosthetic aortic valves. Circulation 137(4):388–399CrossRefPubMed
3.
Figulla HR, Webb JG, Lauten A, Feldman T (2016) The transcatheter valve technology pipeline for treatment of adult valvular heart disease. Eur Heart J 37(28):2226–2239CrossRefPubMed
4.
Lauten A, Laube A, Schubert H, Bischoff S, Nietzsche S, Horstkotter K, Poudel-Bochmann B, Franz M, Lichtenberg A, Figulla HR et al (2015) Transcatheter treatment of tricuspid regurgitation by caval valve implantation–experimental evaluation of decellularized tissue valves in central venous position. Catheter Cardiovasc Interv 85(1):150–160CrossRefPubMed
5.
Hollander KN, Montealegre-Gallegos M, Mahmood F (2016) Valve-in-valve-in homograft: a case of a repeat transcatheter aortic valve replacement in a patient with an aortic homograft. Ann Card Anaesth 19(4):737–739CrossRefPubMedPubMedCentral
6.
7.
Cote N, Pibarot P, Clavel MA (2017) Incidence, risk factors, clinical impact, and management of bioprosthesis structural valve degeneration. Curr Opin Cardiol 32(2):123–129CrossRefPubMed
8.
Senage T, Le Tourneau T, Foucher Y, Pattier S, Cueff C, Michel M, Serfaty JM, Mugniot A, Perigaud C, Carton HF et al (2014) Early structural valve deterioration of Mitroflow aortic bioprosthesis: mode, incidence, and impact on outcome in a large cohort of patients. Circulation 130(23):2012–2020CrossRefPubMed
9.
Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR et al (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364(23):2187–2198CrossRefPubMed
10.
Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR et al (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363(17):1597–1607CrossRefPubMed
11.
Schaefer A, Neumann N, Linder M, Schofer N, Schneeberger Y, Deuschl F, Schoen G, Blankenberg S, Reichenspurner H, Conradi L et al. (2018) Outcomes with a latest generation self-expandable, intra-annular, re-sheathable transcatheter heart valve system: analysis of patients with impaired left ventricular function and determinants for pacemaker implantation. Clin Res Cardiol. https://​doi.​org/​10.​1007/​s00392-018-1263-x CrossRefPubMed
12.
13.
Vernikouskaya I, Rottbauer W, Seeger J, Gonska B, Rasche V, Wohrle J (2018) Patient-specific registration of 3D CT angiography (CTA) with X-ray fluoroscopy for image fusion during transcatheter aortic valve implantation (TAVI) increases performance of the procedure. Clin Res Cardiol 107(6):507–516CrossRefPubMed
14.
Eichler S, Salzwedel A, Harnath A, Butter C, Wegscheider K, Chiorean M, Voller H, Reibis R (2018) Nutrition and mobility predict all-cause mortality in patients 12 months after transcatheter aortic valve implantation. Clin Res Cardiol 107(4):304–311CrossRefPubMed
15.
Gaede L, Kim WK, Liebetrau C, Dorr O, Sperzel J, Blumenstein J, Berkowitsch A, Walther T, Hamm C, Elsasser A et al (2018) Pacemaker implantation after TAVI: predictors of AV block persistence. Clin Res Cardiol 107(1):60–69CrossRefPubMed
16.
Kim WK, Blumenstein J, Liebetrau C, Rolf A, Gaede L, Van Linden A, Arsalan M, Doss M, Tijssen JGP, Hamm CW et al (2017) Comparison of outcomes using balloon-expandable versus self-expanding transcatheter prostheses according to the extent of aortic valve calcification. Clin Res Cardiol 106(12):995–1004CrossRefPubMed
17.
Abdelghani M, Cavalcante R, Miyazaki Y, de Winter RJ, Sarmento-Leite R, Mangione JA, Abizaid A, Lemos PA, Serruys PW, de Brito FS, Jr. (2017) Prevalence, predictors, and prognostic implications of residual impairment of functional capacity after transcatheter aortic valve implantation. Clin Res Cardiol 106(9):752–759
18.
Gonska B, Seeger J, Kessler M, von Keil A, Rottbauer W, Wohrle J (2017) Predictors for permanent pacemaker implantation in patients undergoing transfemoral aortic valve implantation with the Edwards Sapien 3 valve. Clin Res Cardiol 106(8):590–597CrossRefPubMed
19.
Ruile P, Jander N, Blanke P, Schoechlin S, Reinohl J, Gick M, Rothe J, Langer M, Leipsic J, Buettner HJ et al (2017) Course of early subclinical leaflet thrombosis after transcatheter aortic valve implantation with or without oral anticoagulation. Clin Res Cardiol 106(2):85–95CrossRefPubMed
20.
Arsalan M, Filardo G, Kim WK, Squiers JJ, Pollock B, Liebetrau C, Blumenstein J, Kempfert J, Van Linden A, Arsalan-Werner A et al (2016) Prognostic value of body mass index and body surface area on clinical outcomes after transcatheter aortic valve implantation. Clin Res Cardiol 105(12):1042–1048CrossRefPubMed
21.
Kim WK, Meyer A, Mollmann H, Rolf A, Mollmann S, Blumenstein J, Van Linden A, Hamm CW, Walther T, Kempfert J (2016) Cyclic changes in area- and perimeter-derived effective dimensions of the aortic annulus measured with multislice computed tomography and comparison with metric intraoperative sizing. Clin Res Cardiol 105(7):622–629CrossRefPubMed
22.
Schaefer A, Linder M, Treede H, Deuschl F, Schofer N, Seiffert M, Schneeberger Y, Blankenberg S, Reichenspurner H, Schaefer U et al (2016) Applicability of next generation balloon-expandable transcatheter heart valves in aortic annuli exceeding formally approved dimensions. Clin Res Cardiol 105(7):585–591CrossRefPubMed
23.
Kim WK, Liebetrau C, van Linden A, Blumenstein J, Gaede L, Hamm CW, Walther T, Mollmann H (2016) Myocardial injury associated with transcatheter aortic valve implantation (TAVI). Clin Res Cardiol 105(5):379–387CrossRefPubMed
24.
Abdul-Jawad Altisent O, Ferreira-Gonzalez I, Marsal JR, Ribera A, Auger C, Ortega G, Cascant P, Urena M, Del Blanco BG, Serra V et al (2016) Neurological damage after transcatheter aortic valve implantation compared with surgical aortic valve replacement in intermediate risk patients. Clin Res Cardiol 105(6):508–517CrossRefPubMed
25.
Schewel J, Schewel D, Frerker C, Wohlmuth P, Kuck KH, Schafer U (2016) Invasive hemodynamic assessments during transcatheter aortic valve implantation: comparison of patient outcomes in higher vs. lower transvalvular gradients with respect to left ventricular ejection fraction. Clin Res Cardiol 105(1):59–71CrossRefPubMed
26.
Fuchs FC, Hammerstingl C, Sinning JM, Mellert F, Werner N, Grube E, Nickenig G (2016) Antegrade transcatheter mitral valve-in-valve implantation with combined atrial septal defect closure. Clin Res Cardiol 105(5):460–462CrossRefPubMed
27.
Yadlapati A, Groh C, Malaisrie SC, Gajjar M, Kruse J, Meyers S, Passman R (2016) Efficacy and safety of novel oral anticoagulants in patients with bioprosthetic valves. Clin Res Cardiol 105(3):268–272CrossRefPubMed
28.
Lauten A, Ferrari M, Goebel B, Rademacher W, Schumm J, Uth O, Kiehntopf M, Figulla HR, Jung C (2011) Microvascular tissue perfusion is impaired in acutely decompensated heart failure and improves following standard treatment. Eur J Heart Fail 13(7):711–717CrossRefPubMed
29.
30.
Fritzenwanger M, Jung C, Goebel B, Lauten A, Figulla HR (2011) Impact of short-term systemic hypoxia on phagocytosis, cytokine production, and transcription factor activation in peripheral blood cells. Mediators Inflamm 2011:429501CrossRefPubMedPubMedCentral
31.
Buckert D, Cieslik M, Tibi R, Radermacher M, Rasche V, Bernhardt P, Hombach V, Rottbauer W, Wohrle J (2018) Longitudinal strain assessed by cardiac magnetic resonance correlates to hemodynamic findings in patients with severe aortic stenosis and predicts positive remodeling after transcatheter aortic valve replacement. Clin Res Cardiol 107(1):20–29CrossRef
32.
Lauten A, Gerhard-Garcia A, Suhr F, Fischer JH, Figulla HR, Bloch W (2014) Impact of ischemia-reperfusion on extracellular matrix processing and structure of the basement membrane of the heart. PLoS One 9(3):e92833CrossRefPubMedPubMedCentral
33.
Bleiziffer S, Bosmans J, Brecker S, Gerckens U, Wenaweser P, Tamburino C, Linke A, Investigators AS (2017) Insights on mid-term TAVR performance: 3-year clinical and echocardiographic results from the CoreValve ADVANCE study. Clin Res Cardiol 106(10):784–795CrossRefPubMed
34.
35.
Webb JG, Mack MJ, White JM, Dvir D, Blanke P, Herrmann HC, Leipsic J, Kodali SK, Makkar R, Miller DC et al (2017) Transcatheter Aortic valve implantation within degenerated aortic surgical bioprostheses: PARTNER 2 valve-in-valve registry. J Am Coll Cardiol 69(18):2253–2262CrossRefPubMed
36.
Mollmann H, Linke A, Holzhey DM, Walther T, Manoharan G, Schafer U, Heinz-Kuck K, Van Boven AJ, Redwood SR, Kovac J et al (2017) Implantation and 30-day follow-up on all 4 valve sizes within the portico transcatheter aortic bioprosthetic family. JACC Cardiovasc Interv 10(15):1538–1547CrossRefPubMed
37.
Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Munoz DR et al. (2017) 2017 ESC/EACTS guidelines for the management of valvular heart disease: the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European association for cardio-thoracic surgery (EACTS). Eur Heart J 38(36):2739–2791CrossRef
38.
Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT et al (2008) 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease): endorsed by the society of cardiovascular anesthesiologists, society for cardiovascular angiography and interventions, and society of thoracic surgeons. Circulation 118(15):e523–e661PubMed
39.
Leon MB, Piazza N, Nikolsky E, Blackstone EH, Cutlip DE, Kappetein AP, Krucoff MW, Mack M, Mehran R, Miller C et al (2011) Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the valve academic research consortium. Eur Heart J 32(2):205–217CrossRefPubMed
40.
Deeb GM, Chetcuti SJ, Reardon MJ, Patel HJ, Grossman PM, Schreiber T, Forrest JK, Bajwa TK, O’Hair DP, Petrossian G et al (2017) 1-year results in patients undergoing transcatheter aortic valve replacement with failed surgical bioprostheses. JACC Cardiovasc Interv 10(10):1034–1044CrossRefPubMed
41.
Bleiziffer S, Erlebach M, Simonato M, Pibarot P, Webb J, Capek L, Windecker S, George I, Sinning JM, Horlick E et al (2018) Incidence, predictors and clinical outcomes of residual stenosis after aortic valve-in-valve. Heart 104(10):828–834CrossRefPubMed
42.
Pibarot P, Simonato M, Barbanti M, Linke A, Kornowski R, Rudolph T, Spence M, Moat N, Aldea G, Mennuni M et al (2018) Impact of pre-existing prosthesis-patient mismatch on survival following aortic valve-in-valve procedures. JACC Cardiovasc Interv 11(2):133–141CrossRefPubMed
43.
Jung C, Lichtenauer M, Figulla HR, Wernly B, Goebel B, Foerster M, Edlinger C, Lauten A (2017) Microparticles in patients undergoing transcatheter aortic valve implantation (TAVI). Heart Vessels 32(4):458–466CrossRefPubMed
44.
Head SJ, Mokhles MM, Osnabrugge RL, Pibarot P, Mack MJ, Takkenberg JJ, Bogers AJ, Kappetein AP (2012) The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: a systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years. Eur Heart J 33(12):1518–1529CrossRefPubMed
45.
Bleiziffer S, Eichinger WB, Hettich I, Ruzicka D, Wottke M, Bauernschmitt R, Lange R (2008) Impact of patient-prosthesis mismatch on exercise capacity in patients after bioprosthetic aortic valve replacement. Heart 94(5):637–641CrossRefPubMed
46.
Urso S, Sadaba R, Vives M, Trujillo J, Beltrame S, Soriano B, Piqueras L, Aldamiz-Echevarria G (2009) Patient-prosthesis mismatch in elderly patients undergoing aortic valve replacement: impact on quality of life and survival. J Heart Valve Dis 18(3):248–255PubMed
47.
Pibarot P, Weissman NJ, Stewart WJ, Hahn RT, Lindman BR, McAndrew T, Kodali SK, Mack MJ, Thourani VH, Miller DC et al (2014) Incidence and sequelae of prosthesis-patient mismatch in transcatheter versus surgical valve replacement in high-risk patients with severe aortic stenosis: a PARTNER trial cohort—a analysis. J Am Coll Cardiol 64(13):1323–1334CrossRefPubMedPubMedCentral
48.
Wernly B, Lichtenauer M, Jirak P, Eder S, Reiter C, Kammler J, Kypta A, Jung C, Franz M, Hoppe UC et al (2017) Soluble ST2 predicts 1-year outcome in patients undergoing transcatheter aortic valve implantation. Eur J Clin Invest 47(2):149–157CrossRefPubMed
49.
Pilgrim T, Lee JKT, O’Sullivan CJ, Stortecky S, Ariotti S, Franzone A, Lanz J, Heg D, Asami M, Praz F et al (2018) Early versus newer generation devices for transcatheter aortic valve implantation in routine clinical practice: a propensity score matched analysis. Open Heart 5(1):e000695CrossRefPubMedPubMedCentral
50.
Seiffert M, Treede H, Schofer J, Linke A, Woehrle J, Baumbach H, Mehilli J, Bapat V, Simonato M, Walther T et al. (2018) Matched comparison of next- and early-generation balloon-expandable transcatheter heart valve implantations in failed surgical aortic bioprostheses. EuroIntervention. https://​doi.​org/​10.​4244/​EIJ-D-17-00546 CrossRefPubMed
Metadata
Title
Transcatheter valve-in-valve implantation (VinV-TAVR) for failed surgical aortic bioprosthetic valves
Authors
Bernhard Wernly
Ann-Katrin Zappe
Axel Unbehaun
Jan-Malte Sinning
Christian Jung
Won-Keun Kim
Stephan Fichtlscherer
Michael Lichtenauer
Uta C. Hoppe
Brunilda Alushi
Frederik Beckhoff
Charlotte Wewetzer
Marcus Franz
Daniel Kretzschmar
Eliano Navarese
Ulf Landmesser
Volkmar Falk
Alexander Lauten
Publication date
01-01-2019
Publisher
Springer Berlin Heidelberg
Published in
Clinical Research in Cardiology / Issue 1/2019
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-018-1326-z

Other articles of this Issue 1/2019

Clinical Research in Cardiology 1/2019 Go to the issue

Original Paper

Novel ECG-based scoring tool for prediction of takotsubo syndrome

Original Paper

Renal sympathetic denervation induces changes in heart rate variability and is associated with a lower sympathetic tone

Original Paper

Gender-dependent association of diabetes mellitus with mortality in patients undergoing transcatheter aortic valve replacement

Correction

Correction to: Transcatheter valve-in-valve implantation (VinV-TAVR) for failed surgical aortic bioprosthetic valves

Review

Aortic annulus sizing in stenotic bicommissural non-raphe-type bicuspid aortic valves: reconstructing a three-dimensional structure using only two hinge points

Original Paper

Long-term effects of device-guided slow breathing in stable heart failure patients with reduced ejection fraction

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits