Introduction
The clinical implementation of transcatheter aortic valve replacement
(TAVR) induced profound and ongoing changes in treatment of valvular
heart disease [1-3]. Since the first successful TAVR, as reported by
Alain Cribier in 2002, TAVR has advanced to an essential part in
contemporary heart valve therapy [4].
At the same time, surgical aortic valve replacement (AVR) experienced
significant changes too [2]. Today, bioprosthetic valves are
preferred over mechanical valves by physicians and patients. Recently,
more than 80% of all surgically implanted valves are biologic
substitutes [2, 5-7]. Even industry adopted this trend and brought
“valve-in-valve-TAVR-ready”-implants into the market [8]. Despite
reported long-term results for more than 20 years, the basically limited
durability of bioprosthetic valves still is an important issue [9].
For those reasons, a significant number of patients presenting with a
failed aortic bioprosthesis will be upcoming in the near future. Most of
those patients are suitable for conventional redo-surgery at nearly
normal risk. But for some higher risk subgroups, undoubted a
significantly increased risk for mortality or morbidity up to 20% is
reported [2, 5, 10, 11].
An alternative to surgical redo AVR, is “valve-in-valve” TAVR
(VIV-TAVR) for failed aortic bioprostheses, as firstly described by
Walther et al. in 2007 [2, 3, 12]. Since then, VIV-TAVR continuously
spread into the TAVR-centers and today is an established treatment
option.
Already in 2014 Dvir et al. reported the initial outcomes of VIV-TAVR in
the largest multicenter valve-in-valve registry, including 459 patients
and 55 centers worldwide [13]. In this work, Dvir demonstrated the
feasibility and safety of the VIV-procedure in a large multicentric
cohort [13]. The initial results confirmed good immediate and
one-year outcomes [13]. But already this early study described
inferior results for patients with small prosthesis and predominant
valve stenosis [13].
Up today, there exists only little information concerning mid-term, and
no information about long-term durability of VIV-TAVR. The presently
available studies contain only limited data, mostly reporting a
follow-up limited to one year ([13-16]. Recently, a sub-analysis of
the PARTNER 2-registry reported 3-year outcomes, but under exclusion of
bioprosthetic valves with a labeled diameter less than 21mm [17].
The longest follow-up is provided by Bleiziffer et al., reporting
5-years clinical data of the VIVI-registry, but lacking
echocardiographic data [18].
To address this lack of knowledge in present literature, this study adds
a 3-years echocardiographic follow-up after VIV-TAVR.