Outcomes Following Transcatheter Aortic Valve Replacement for Degenerative Stentless Versus Stented Bioprostheses

被引：45

作者：

Duncan, Alison ^{[1
]}

Moat, Neil ^{[1
]}

Simonato, Matheus ^{[2
]}

de Weger, Arend ^{[3
]}

Kempfert, Jorg ^{[4
]}

Eggebrecht, Holger ^{[5
]}

Walton, Antony ^{[6
]}

Hellig, Farrel ^{[7
]}

Kornowski, Ran ^{[8
]}

Spargias, Konstantinos ^{[9
]}

Mendiz, Oscar ^{[10
]}

Makkar, Raj ^{[11
]}

Guerrero, Mayra ^{[12
]}

Rihal, Charm ^{[12
]}

George, Isaac ^{[13
]}

Don, Creighton ^{[14
]}

Iadanza, Alessandro ^{[15
]}

Bapat, Vinayak ^{[13
]}

Welsh, Robert ^{[16
]}

Wijeysundera, Harindra C. ^{[17
]}

Wood, David ^{[18
]}

Sathananthan, Janarthanan ^{[19
]}

Danenberg, Haim ^{[20
]}

Maisano, Francesco ^{[21
]}

Garcia, Santiago ^{[22
]}

Gafoor, Sameer ^{[23
]}

Nombela-Franco, Luis ^{[24
]}

Cobiella, Javier ^{[24
]}

Dvir, Danny ^{[14
]}

机构：

[1] Royal Brompton Hosp, London, England

[2] Univ Fed Sao Paulo, Escola Paulista Med, Sao Paulo, Brazil

[3] Leids Univ, Med Ctr, Leiden, Netherlands

[4] Deutsch Herzzentrum Berlin, Berlin, Germany

[5] Cardioangiol Ctr Bethanien, Frankfurt, Germany

[6] Alfred Hlth, Melbourne, Vic, Australia

[7] Sunninghill Hosp, Johannesburg, South Africa

[8] Rabin Med Ctr, Petah Tiqwa, Israel

[9] Hygeia Hosp, Athens, Greece

[10] Fdn Favaloro, Buenos Aires, DF, Argentina

[11] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA

[12] Mayo Clin, Rochester, MN USA

[13] Columbia Univ, New York, NY USA

[14] Univ Washington, Seattle, WA 98195 USA

[15] Azienda Osped Univ Senese, Siena, Italy

[16] Univ Alberta, Edmonton, AB, Canada

[17] Sunnybrook Med Ctr, Toronto, ON, Canada

[18] Vancouver Gen Hosp, Vancouver, BC, Canada

[19] St Pauls Hosp, Vancouver, BC, Canada

[20] Hadassah Med Ctr, Jerusalem, Israel

[21] Univ Spital Zurich, Zurich, Switzerland

[22] Univ Minnesota, Minneapolis, MN USA

[23] Swedish Med Ctr, Seattle, WA USA

[24] Hosp Clin San Carlos, Madrid, Spain

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2019年 / 12卷 / 13期

关键词：

stented bioprostheses; stentless bioprostheses; transcatheter aortic valve replacement; valve-in-valve; CORONARY OBSTRUCTION; IMPLANTATION; SOCIETY;

D O I：

10.1016/j.jcin.2019.02.036

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES A large comprehensive analysis of transcatheter aortic valve replacement (TAVR) was performed for failed stentless bioprostheses. BACKGROUND Valve-in-valve (ViV) transcatheter aortic replacement (TAVR) is an alternative to redo surgery for patients with a failing aortic bioprosthesis. METHODS Unadjusted outcome data were collected from the VIVID (Valve-in-Valve International Data) registry between 2007 and 2016 from a total of 1,598 aortic ViV procedures (291 stentless, 1,307 stented bioprostheses). RESULTS Bioprosthetic failure was secondary to aortic regurgitation in 56% of stentless and 20% stented devices (p < 0.001). ViV-TAVR access was transfemoral in 71.1% stentless and 74.2% stented ViV-TAVR. Self-expanding devices were more frequently used in stentless ViV-TAVR (56.0% vs. 39.9%; p = 0.05), but there was no difference between balloon-expanding and self-expanding TAVR devices for stented ViV-TAVR (48.6% vs. 45.1%). The degree of oversizing for all mechanisms of bioprosthesis failure was 9 +/- 10% for stentless ViV-TAVR vs. 6 +/- 9% for stented ViV-TAVR (and 8 +/- 10% for stentless ViV-TAVR vs. 3 +/- 9% for stented ViV-TAVR in patients with predominant aortic regurgitation; both p < 0.001). Initial device malposition (10.3% vs. 6.2%; p = 0.014), second transcatheter device (7.9% vs. 3.4%), coronary obstruction (6.0% vs. 1.5%), and paravalvular leak occurred more frequently in stentless ViV-TAVR (all p < 0.001). Hospital stay duration (median 7 days) was no different, and 30-day (6.6% vs. 4.4%; p = 0.12) and 1-year mortality year (15.8% vs. 12.6%; p = 0.15) were numerically higher, but not statistically different, after stentless ViV-TAVR. CONCLUSIONS Stentless ViV-TAVR is associated with greater periprocedural complications (initial device malposition, second transcatheter device, coronary obstruction, paravalvular leak), but no difference in 30-day and 1-year outcome. (C) 2019 by the American College of Cardiology Foundation.

引用

页码：1256 / 1263

页数：8

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