Clinical and hemodynamic outcomes for transcatheter aortic valve implantation in internally stented surgical valve -Comparison of Balloon- and Self-Expandable Valves-

BackgroundValve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is indicated in patients undergoing repeat interventions for degenerative aortic valve bioprostheses. Patients with internally stented surgical valves (IS) (Mitroflow and Trifecta) are at a high risk for coronary artery obstruction during the ViV procedure. This study aimed to evaluate the mid-term clinical and hemodynamic outcomes of balloon-expandable valves (BEV) and supra-annular self-expanding valves (SEV) for TAVI within the IS. MethodsBaseline characteristics, hemodynamic parameters, and clinical outcomes of patients who underwent ViV for IS treated with BEV and SEV were retrospectively collected. Outcomes were compared using propensity score matching (PSM). ResultsIn total, 113 patients were included this analysis. Sixty-three patients (55.8%) underwent BEV, and fifty patients (44.2%) underwent SEV. Overall, 37 pairs were identified after PSM. At 30-day, the clinical and hemodynamic outcomes were similar between the groups. Patients with SEV had better post-procedural mean gradient at 1-year compared with those with BEV (22.7{+/-}8.4 mmHg vs 11.7{+/-}4.3 mmHg; p<0.001). There was no significant difference between SEV and BEV in the cumulative 2-year composite endpoint, including all-cause of mortality, hospitalization for heart failure, and coronary obstruction (log-rank p=0.489) ConclusionsIn patients who underwent ViV for IS, the early- and mid-term clinical outcomes were comparable between BEV and SEV. Meanwhile, the 1-year hemodynamics seemed to be better in patients with SEV than in those with BEV. Clinical PerspectiveWhat is new? O_LIMid-term clinical outcomes, including all-cause mortality, heart failure rehospitalization, and coronary obstruction, were similar between balloon-expandable valve (BEV) and self-expanding valve (SEV) in valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) for internally stented surgical valves (IS). C_LIO_LISEV group has lower transvalvular gradients at 1-yearfollow-up than BEV group, while the occurrence of coronary obstruction were similar. C_LI What are the Clinical Implications? O_LIIndividualized device selection and improving pre-operative screening for a risk of coronary obstruction, patient-specific anatomical and procedural factors can help the better clinical outcomes. C_LI