Transcatheter valve-in-valve aortic valve replacement for degenerated aortic surgical bioprostheses: A retrospective study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Shaopeng , ZHAO Feng , BAI Yunpeng , FU Bo , CHEN Tongyun , LI Jinghui ,  CHEN Qingliang ,  JIANG Nan

Department of Cardiac Surgery, Tianjin University Chest Hospital, Tianjin Institute of Cardiovascular Disease, Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care, Tianjin, 300070, P. R. China;

Corresponding author：

CHEN Qingliang, Email: jiangnantj@126.com; JIANG Nan, Email: qingliang1971@126.com

Keywords：

Transcatheter valve-in-valve surgery; failed bioprosthetic valve; self-expanding valve; aortic valve

DOI：

10.7507/1007-4848.202312020

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Objective To summarize the results and clinical experience of transcatheter valve-in-valve implantation using domestic self-expanding valve in patients with aortic degenerated bio-prosthesis. Methods From January 2019 to April 2023, the patients who underwent transcatheter valve-in-valve surgery in the Department of Cardiac Surgery of Tianjin Chest Hospital due to surgical bio-prosthesis failure were included. Characteristics of valves, perioperative complications, and hemodynamic manifestations during the early postoperative and follow-up period were analyzed. Results A total of 24 patients were enrolled, including 14 males and 10 females with an average age of 68.17±7.72 years, and the average interval between the two operations was 10.48±4.09 years. All patients were successfully discharged without complications such as coronary artery obstruction and pacemaker implantation, and the average transvalvular pressure gradient was 16.39±6.52 mm Hg before discharge. During the median follow-up time of 16 months, the left ventricular diastolic inner diameter and ejection fraction were continuously improved. Conclusion Transcatheter valve-in-valve using domestic self-expanding valves is safe and feasible to treat aortic bioprosthetic valve failure. Sound patient selection and surgical strategies are critical to achieve good hemodynamics.

Citation： ZHANG Shaopeng, ZHAO Feng, BAI Yunpeng, FU Bo, CHEN Tongyun, LI Jinghui, CHEN Qingliang, JIANG Nan. Transcatheter valve-in-valve aortic valve replacement for degenerated aortic surgical bioprostheses: A retrospective study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(6): 842-847. doi: 10.7507/1007-4848.202312020 Copy

1.	Kostyunin AE, Yuzhalin AE, Rezvova MA, et al. Degeneration of bioprosthetic heart valves: Update 2020. J Am Heart Assoc, 2020, 9(19): e018506.
2.	Piperata A, Fiocco A, Cavicchiolo A, et al. Carpentier-Edwards Magna Ease bioprosthesis: A multicentre clinical experience and 12-year durability. Eur J Cardiothorac Surg, 2022, 61(4): 888-896.
3.	曾咏, 朱齐丰, 陈俊, 等. 主动脉瓣生物瓣长期耐久性的研究进展. 中国循环杂志, 2021, 36(10): 1031-1035.
4.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e72-e227.
5.	周亚雄. 经导管瓣中瓣治疗生物瓣退化的现状及前景. 中国胸心血管外科临床杂志, 2024, 31(5):800-806.
6.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease: Developed by the Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol (Engl Ed), 2022, 75(6): 524.
7.	Dvir D, Bourguignon T, Otto CM, et al. Standardized definition of structural valve degeneration for surgical and transcatheter bioprosthetic aortic valves. Circulation, 2018, 137(4): 388-399.
8.	Wenaweser P, Buellesfeld L, Gerckens U, et al. Percutaneous aortic valve replacement for severe aortic regurgitation in degenerated bioprosthesis: The first valve in valve procedure using the Corevalve Revalving system. Catheter Cardiovasc Interv, 2007, 70(5): 760-764.
9.	Hahn RT, Webb J, Pibarot P, et al. 5-year follow-up from the PARTNER 2 aortic valve-in-valve registry for degenerated aortic surgical bioprostheses. JACC Cardiovasc Interv, 2022, 15(7): 698-708.
10.	Sá MPBO, Van den Eynde J, Simonato M, et al. Valve-in-valve transcatheter aortic valve replacement versus redo surgical aortic valve replacement: An updated meta-analysis. JACC Cardiovasc Interv, 2021, 14(2): 211-220.
11.	Landes U, Sathananthan J, Witberg G, et al. Transcatheter replacement of transcatheter versus surgically implanted aortic valve bioprostheses. J Am Coll Cardiol, 2021, 77(1): 1-14.
12.	Yousef S, Serna-Gallegos D, Iyanna N, et al. Valve-in-valve transcatheter aortic valve replacement versus isolated redo surgical aortic valve replacement. J Thorac Cardiovasc Surg, 2023, S0022-5223.
13.	Sá MP, Van den Eynde J, Simonato M, et al. Late outcomes of valve-in-valve transcatheter aortic valve implantation versus re-replacement: Meta-analysis of reconstructed time-to-event data. Int J Cardiol, 2023, 370: 112-121.
14.	Nielsen PH, Hjortdal V, Modrau IS, et al. Durability after aortic valve replacement with the Mitroflow versus the Perimount pericardial bioprosthesis: A single-centre experience in 2393 patients. Eur J Cardiothorac Surg, 2016, 49(6): 1705-1710.
15.	Sadat N, Scharfschwerdt M, Schaller T, et al. Functional performance of 8 small surgical aortic valve bioprostheses: An in vitro study. Eur J Cardiothorac Surg, 2022, 62(4): ezac426.
16.	Sadat N, Bruhn D, Scharfschwerdt M, et al. Impact of different valve-in-valve positions on the hydrodynamic performance of the newest-generation self-expanding transcatheter heart valve. Eur J Cardiothorac Surg, 2022, 62(5): ezac158.
17.	Fukui M, Sorajja P, Cavalcante JL, et al. Deformation of transcatheter heart valve following valve-in-valve transcatheter aortic valve replacement: Implications for hemodynamics. JACC Cardiovasc Interv, 2023, 16(5): 515-526.
18.	Chhatriwalla AK, Allen KB, Depta JP, et al. Outcomes of bioprosthetic valve fracture in patients undergoing valve-in-valve TAVR. JACC Cardiovasc Interv, 2023, 16(5): 530-539.
19.	Bernardi FLM, Dvir D, Rodes-Cabau J, et al. Valve-in-valve challenges: How to avoid coronary obstruction. Front Cardiovasc Med, 2019, 6: 120.
20.	AlBadri A, Joseph J, Patel V, et al. Hemodynamic and mid-term outcomes for transcatheter aortic valve replacement in degenerated internally stented valves. JACC Cardiovasc Interv, 2023, 16(5): 542-554.
21.	Lederman RJ, Babaliaros VC, Rogers T, et al. Preventing coronary obstruction during transcatheter aortic valve replacement: From computed tomography to BASILICA. JACC Cardiovasc Interv, 2019, 12(13): 1197-1216.

1. Kostyunin AE, Yuzhalin AE, Rezvova MA, et al. Degeneration of bioprosthetic heart valves: Update 2020. J Am Heart Assoc, 2020, 9(19): e018506.
2. Piperata A, Fiocco A, Cavicchiolo A, et al. Carpentier-Edwards Magna Ease bioprosthesis: A multicentre clinical experience and 12-year durability. Eur J Cardiothorac Surg, 2022, 61(4): 888-896.
3. 曾咏, 朱齐丰, 陈俊, 等. 主动脉瓣生物瓣长期耐久性的研究进展. 中国循环杂志, 2021, 36(10): 1031-1035.
4. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e72-e227.
5. 周亚雄. 经导管瓣中瓣治疗生物瓣退化的现状及前景. 中国胸心血管外科临床杂志, 2024, 31(5):800-806.
6. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease: Developed by the Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol (Engl Ed), 2022, 75(6): 524.
7. Dvir D, Bourguignon T, Otto CM, et al. Standardized definition of structural valve degeneration for surgical and transcatheter bioprosthetic aortic valves. Circulation, 2018, 137(4): 388-399.
8. Wenaweser P, Buellesfeld L, Gerckens U, et al. Percutaneous aortic valve replacement for severe aortic regurgitation in degenerated bioprosthesis: The first valve in valve procedure using the Corevalve Revalving system. Catheter Cardiovasc Interv, 2007, 70(5): 760-764.
9. Hahn RT, Webb J, Pibarot P, et al. 5-year follow-up from the PARTNER 2 aortic valve-in-valve registry for degenerated aortic surgical bioprostheses. JACC Cardiovasc Interv, 2022, 15(7): 698-708.
10. Sá MPBO, Van den Eynde J, Simonato M, et al. Valve-in-valve transcatheter aortic valve replacement versus redo surgical aortic valve replacement: An updated meta-analysis. JACC Cardiovasc Interv, 2021, 14(2): 211-220.
11. Landes U, Sathananthan J, Witberg G, et al. Transcatheter replacement of transcatheter versus surgically implanted aortic valve bioprostheses. J Am Coll Cardiol, 2021, 77(1): 1-14.
12. Yousef S, Serna-Gallegos D, Iyanna N, et al. Valve-in-valve transcatheter aortic valve replacement versus isolated redo surgical aortic valve replacement. J Thorac Cardiovasc Surg, 2023, S0022-5223.
13. Sá MP, Van den Eynde J, Simonato M, et al. Late outcomes of valve-in-valve transcatheter aortic valve implantation versus re-replacement: Meta-analysis of reconstructed time-to-event data. Int J Cardiol, 2023, 370: 112-121.
14. Nielsen PH, Hjortdal V, Modrau IS, et al. Durability after aortic valve replacement with the Mitroflow versus the Perimount pericardial bioprosthesis: A single-centre experience in 2393 patients. Eur J Cardiothorac Surg, 2016, 49(6): 1705-1710.
15. Sadat N, Scharfschwerdt M, Schaller T, et al. Functional performance of 8 small surgical aortic valve bioprostheses: An in vitro study. Eur J Cardiothorac Surg, 2022, 62(4): ezac426.
16. Sadat N, Bruhn D, Scharfschwerdt M, et al. Impact of different valve-in-valve positions on the hydrodynamic performance of the newest-generation self-expanding transcatheter heart valve. Eur J Cardiothorac Surg, 2022, 62(5): ezac158.
17. Fukui M, Sorajja P, Cavalcante JL, et al. Deformation of transcatheter heart valve following valve-in-valve transcatheter aortic valve replacement: Implications for hemodynamics. JACC Cardiovasc Interv, 2023, 16(5): 515-526.
18. Chhatriwalla AK, Allen KB, Depta JP, et al. Outcomes of bioprosthetic valve fracture in patients undergoing valve-in-valve TAVR. JACC Cardiovasc Interv, 2023, 16(5): 530-539.
19. Bernardi FLM, Dvir D, Rodes-Cabau J, et al. Valve-in-valve challenges: How to avoid coronary obstruction. Front Cardiovasc Med, 2019, 6: 120.
20. AlBadri A, Joseph J, Patel V, et al. Hemodynamic and mid-term outcomes for transcatheter aortic valve replacement in degenerated internally stented valves. JACC Cardiovasc Interv, 2023, 16(5): 542-554.
21. Lederman RJ, Babaliaros VC, Rogers T, et al. Preventing coronary obstruction during transcatheter aortic valve replacement: From computed tomography to BASILICA. JACC Cardiovasc Interv, 2019, 12(13): 1197-1216.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Transcatheter valve-in-valve aortic valve replacement for degenerated aortic surgical bioprostheses: A retrospective study in a single center

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