Background VIV-TAVR is established and provides good
initial clinical and hemodynamic outcomes. Lacking long-term durability
data baffle the expand to lower risk patients. For those purposes, the
present study adds a hemodynamic 3-years follow-up.
Methods A total of 77 patients underwent VIV-TAVR for
failing aortic bioprosthesis during a 7-years period. Predominant mode
of failure was stenosis in 87.0%. Patients had a mean age of 79.4±5.8
years and a mean logistic EuroSCORE of 30.8±15.7%. The STS-PROM
averaged 5.79±2.63%. Clinical results and hemodynamic outcomes are
reported for 30-days, 1-, 2- and 3-years. Completeness of follow-up was
100% with 44 patients at risk after 3-years. Follow-up ranged up to 7.1
years. Results Majority of the surgical valves were
stented (94.8%) with a mean labeled size of 23.1±2.3mm and true-ID of
20.4±2.6mm. A true-ID ≤21mm had 58.4% of the patients. Self-expanding
valves were implanted in 68.8% (mean labeled size 24.1±1.8mm) and
balloon-expanded in 31.2% (mean size 24.1±1.8mm). No patient died
intraoperatively. Hospital mortality was 1.3% and three-years survival
57.1%. All patients experienced an initial significant dPmean-reduction
to 16.8±7.1mmHg. After 3-years mean dPmean raised to 26.0±12.2mmHg. This
observation was independent from true-ID or type of TAVR-prosthesis.
Patients with a true-ID ≤21mm had a higher initial (18.3±5.3mmHg vs.
14.9±7.1mmHg; p=0.005) and dPmean after 1-year (29.2±8.2mmHg vs.
13.0±6.7mmHg; p=0.004). There were no significant differences in
survival. Conclusions VIV-TAVR is safe and effective in
the early period. In surgical valves with a true-ID≤21mm inferior
hemodynamic and survival outcomes must be expected. Nonetheless, also
patients with larger true-ID’s showed steadily increasing transvalvular
gradients. This raises concern about durability.