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39 Valve-in-valve transcatheter aortic valve implantation in trifecta aortic bioprostheses – a single centre experience
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  1. Benoy Shah1,
  2. Syed Haider1,
  3. John Rawlins2,
  4. Alison Calver2,
  5. Simon Corbett2,
  6. Dhrubo Rakhit1,
  7. Sunil Ohri1,
  8. Nick Curzen2
  1. 1University Hospital Southampton NHS Foundation Trust, Southampton, UK
  2. 2University Hospital Southampton

Abstract

Introduction Valve-in-valve transcatheter aortic valve implantation (V-in-V TAVI) has become an increasingly popular alternative to re-do surgery for patients with failing aortic bioprosthetic valves. The Trifecta aortic valve replacement (AVR), designed for supra-annular insertion, consists of a titanium stent with externally mounted leaflets fashioned from bovine pericardium. Several studies have reported premature structural degeneration of the Trifecta valve. There are currently few data regarding the feasibility & efficacy of V-in-V TAVI within Trifecta bioprostheses.

Methods This represents a retrospective review of prospectively collected data at our centre for TAVI procedures performed between January 1st 2015 and December 31st 2020 inclusive. In cases of V-in-V TAVI to treat a failing Trifecta valve, we collected demographic, procedural, echocardiographic and short-term follow-up data from electronic records systems for both this NHS Trust and primary care.

Results Over a 6-year period, we performed 549 TAVI procedures, of which 51 (9.3%) were V-in-V cases. Of these 51, 15 (29%) were for patients with failing Trifecta valves (9 female, mean age 80.9 ± 5.6yrs;. predominant stenosis in 5 & transvalvular regurgitation in 10). Figures 1 & 2 demonstrate examples of prosthesis stenosis & prosthesis regurgitation treated by V-in-V TAVI. The median time from original AVR to V-in-V TAVI procedure was 59 months (IQR 36.5, range 16–93 months). All procedures were performed via the transfemoral route and 13/15 under conscious sedation. A balloon-expandable TAVI valve was used in 14 patients & a self-expanding valve in 1 patient. Post-procedural echocardiography revealed a mean aortic peak velocity 2.9 ± 0.4m/s & mean aortic gradient 19 ± 5mmHg. Paravalvular aortic regurgitation was absent in 7 cases, trivial in 6 & mild in 2 patients. In-hospital and 30-day mortality were 0%. There were three deaths during follow-up (36, 14 & 3 months post procedure), all of which were non-cardiac in nature.

Conclusion V-in-V TAVI is a safe and feasible alternative to re-do surgical AVR for patients with a failing Trifecta aortic bioprosthesis. Unlike other bioprosthetic valves, the Trifecta valve cannot be fractured to enable a larger V-in-V TAVI valve to be implanted. Thus, longer term follow-up of such patients will allow a full understanding of the long-term haemodynamic and clinical outcomes in this patient cohort.

Conflict of Interest Nil

  • Transcatheter aortic valve implantation
  • aortic valve disease
  • echocardiography

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