Transcatheter aortic valve implantation in degenerated trans-catheter and surgical bioprosthetic aortic valve

Abstract Background The moving forward indication of transcatheter aortic valve implantation (TAVI) to younger aortic valve stenosis (AS) patients might lead to degenerated trans-catheter heart valve (TAV) issues which need re-intervention. TAVI in a degenerated bioprosthetic surgical valve (SAV) is feasible. However, the results of TAVI-in-TAV when compare to TAVI-in-SAV have been rarely reported. Purpose The aims of this study is to compare device success, early safety events at 30 days, clinical efficacy events after 30 days, and time related valve safety events between TAVI-in-TAV and TAVI-in-SAV. Methods Retrospectively analysed data from 62 consecutive patients with degenerated TAV or SAV who received TAVI at our Scientific institute from January 2016 to June 2020. Results 10 patients who received TAVI-in-TAV and 52 patients who received TAVI-in-SAV were included. The patient median age was 78 years and 60% was male. The median STS score was significantly higher in TAVI-in-TAV compared to TAVI-in-SAV groups; 7.80% vs. 3.30% respectively, p=0.006. The age of the first bioprosthetic was longer in TAVI-in-SAV compared to TAV-in-SAV group; 9.8 versus 5.3 years, respectively. All TAVI devices used in both groups were second generation. The device success rate, early safety at 30 days, clinical efficacy events at median 2-years follow up were comparable; 90% vs. 88.5%, 80% vs. 76.9%, 70% vs. 44.2%, in TAVI-in-TAV and TAVI-in-SAV groups respectively. All-cause mortality at 2-years follow up was comparable; 10% vs. 9.8% in TAVI-in-SAV and TAVI-in-SAV groups, respectively. Time related valve safety events at 2-years follow up was comparable; 30% vs. 26.9% in TAVI-in-TAV and TAVI-in-SAV groups respectively. Most valve safety events were related to residual high trans-aortic valve gradient which found only in small first bioprosthetic valve. The rate of new permanent pacemaker implantation was 16.7% in both groups. The coronary obstruction found was 19.2% in TAVI-in-SAV group. Conclusions TAVI-in-TAV is feasible and comparable on device success, immediate and 2-years follow up outcomes compared to TAVI-in-SAV. Larger studies with longer-term follow-up time are needed to confirm these results as well as the upstream management of AS patient with long life expectancy. Funding Acknowledgement Type of funding sources: None. Conclusion