Valve-in-valve transcatheter aortic valve replacement (TAVR) leads to lower device success compared to TAVR in native stenosis
BackgroundDespite the lack of randomized-controlled trials in patients with failed bioprosthetic valves, valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is increasingly used.MethodsOutcomes of consecutive patients treated with ViV-TAVR (N = 100) at our tertiary heart center between...
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Frontiers Media S.A.
2025-04-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1465409/full |
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| author | Michael Paukovitsch Bartu Dilaver Dominik Felbel Marvin Krohn-Grimberghe Dominik Buckert Johannes Moerike Leonhard Moritz Schneider Christian Liewald Wolfgang Rottbauer Birgid Gonska |
| author_facet | Michael Paukovitsch Bartu Dilaver Dominik Felbel Marvin Krohn-Grimberghe Dominik Buckert Johannes Moerike Leonhard Moritz Schneider Christian Liewald Wolfgang Rottbauer Birgid Gonska |
| author_sort | Michael Paukovitsch |
| collection | DOAJ |
| description | BackgroundDespite the lack of randomized-controlled trials in patients with failed bioprosthetic valves, valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is increasingly used.MethodsOutcomes of consecutive patients treated with ViV-TAVR (N = 100) at our tertiary heart center between 2014 and 2022 were compared to TAVR (N = 2216) in native valves.ResultsPatients median age was 78.5 years (IQR 70.0–84.0) in ViV-TAVR compared to 81.0 (IQR 77.0–85.0) in patients with native aortic stenosis (p < 0.01) with a similar percentage of females in both groups (42% vs. 49.3%, p = 0.18). The median Society of Thoracic Surgeons score for mortality was significantly higher in patients undergoing ViV-TAVR [5.1% {IQR 2.6%–8.6%} vs. 3.8% {IQR 2.4%–6.3%}, p < 0.01]. ViV-TAVR was performed in degenerated surgical bioprostheses in 88% and in degenerated transcatheter bioprostheses in 12%. Stenosis was the main mechanism of bioprosthetic valve failure (70%), whereas severe regurgitation was the leading cause in 30%. The overall rate of device success amounted to 66% in ViV-TAVR, compared to 96.1% in TAVR (p < 0.01) and ViV-TAVR was independently associated with reduced device success (OR: 0.07, 95%CI: 0.045–0.12, p < 0.01) in multivariate regression. While ViV-TAVR decreased peak and mean gradients significantly, in 31% of patients elevated mean gradients (≥20 mmHg) were observed at discharge. Small native prosthesis diameter (<20 mm) was the strongest predictor (OR 3.8, 95%CI: 1.5–9.2, p = 0.01) independently associated with elevated gradients after ViV-TAVR.ConclusionViV-TAVR for treatment of degenerated bioprostheses improves aortic valve function. However, device success is lower compared to TAVR in native aortic valve disease, mainly due to elevated postprocedural mean gradients, especially in small bioprostheses. |
| format | Article |
| id | doaj-art-28c5b52fd48e4d5295ca7ff76bf6bd5c |
| institution | OA Journals |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-28c5b52fd48e4d5295ca7ff76bf6bd5c2025-08-20T02:24:30ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-04-011210.3389/fcvm.2025.14654091465409Valve-in-valve transcatheter aortic valve replacement (TAVR) leads to lower device success compared to TAVR in native stenosisMichael Paukovitsch0Bartu Dilaver1Dominik Felbel2Marvin Krohn-Grimberghe3Dominik Buckert4Johannes Moerike5Leonhard Moritz Schneider6Christian Liewald7Wolfgang Rottbauer8Birgid Gonska9Department of Cardiology, Ulm University Heart Center, Ulm, GermanyDepartment of Cardiology, Ulm University Heart Center, Ulm, GermanyDepartment of Cardiology, Ulm University Heart Center, Ulm, GermanyDepartment of Cardiology, Ulm University Heart Center, Ulm, GermanyDepartment of Cardiology, Ulm University Heart Center, Ulm, GermanyDepartment of Cardiology, Ulm University Heart Center, Ulm, GermanyDepartment of Cardiology, Ulm University Heart Center, Ulm, GermanyDepartment of Cardiothoracic and Vascular Surgery, Ulm University Heart Center, Ulm, GermanyDepartment of Cardiology, Ulm University Heart Center, Ulm, GermanyDepartment of Cardiology, Ulm University Heart Center, Ulm, GermanyBackgroundDespite the lack of randomized-controlled trials in patients with failed bioprosthetic valves, valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is increasingly used.MethodsOutcomes of consecutive patients treated with ViV-TAVR (N = 100) at our tertiary heart center between 2014 and 2022 were compared to TAVR (N = 2216) in native valves.ResultsPatients median age was 78.5 years (IQR 70.0–84.0) in ViV-TAVR compared to 81.0 (IQR 77.0–85.0) in patients with native aortic stenosis (p < 0.01) with a similar percentage of females in both groups (42% vs. 49.3%, p = 0.18). The median Society of Thoracic Surgeons score for mortality was significantly higher in patients undergoing ViV-TAVR [5.1% {IQR 2.6%–8.6%} vs. 3.8% {IQR 2.4%–6.3%}, p < 0.01]. ViV-TAVR was performed in degenerated surgical bioprostheses in 88% and in degenerated transcatheter bioprostheses in 12%. Stenosis was the main mechanism of bioprosthetic valve failure (70%), whereas severe regurgitation was the leading cause in 30%. The overall rate of device success amounted to 66% in ViV-TAVR, compared to 96.1% in TAVR (p < 0.01) and ViV-TAVR was independently associated with reduced device success (OR: 0.07, 95%CI: 0.045–0.12, p < 0.01) in multivariate regression. While ViV-TAVR decreased peak and mean gradients significantly, in 31% of patients elevated mean gradients (≥20 mmHg) were observed at discharge. Small native prosthesis diameter (<20 mm) was the strongest predictor (OR 3.8, 95%CI: 1.5–9.2, p = 0.01) independently associated with elevated gradients after ViV-TAVR.ConclusionViV-TAVR for treatment of degenerated bioprostheses improves aortic valve function. However, device success is lower compared to TAVR in native aortic valve disease, mainly due to elevated postprocedural mean gradients, especially in small bioprostheses.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1465409/fullvalve in valve aortic replacementbioprosthetic valve degenerationtranscatheter aortic replacementdevice successbioprosthetic valve failure |
| spellingShingle | Michael Paukovitsch Bartu Dilaver Dominik Felbel Marvin Krohn-Grimberghe Dominik Buckert Johannes Moerike Leonhard Moritz Schneider Christian Liewald Wolfgang Rottbauer Birgid Gonska Valve-in-valve transcatheter aortic valve replacement (TAVR) leads to lower device success compared to TAVR in native stenosis Frontiers in Cardiovascular Medicine valve in valve aortic replacement bioprosthetic valve degeneration transcatheter aortic replacement device success bioprosthetic valve failure |
| title | Valve-in-valve transcatheter aortic valve replacement (TAVR) leads to lower device success compared to TAVR in native stenosis |
| title_full | Valve-in-valve transcatheter aortic valve replacement (TAVR) leads to lower device success compared to TAVR in native stenosis |
| title_fullStr | Valve-in-valve transcatheter aortic valve replacement (TAVR) leads to lower device success compared to TAVR in native stenosis |
| title_full_unstemmed | Valve-in-valve transcatheter aortic valve replacement (TAVR) leads to lower device success compared to TAVR in native stenosis |
| title_short | Valve-in-valve transcatheter aortic valve replacement (TAVR) leads to lower device success compared to TAVR in native stenosis |
| title_sort | valve in valve transcatheter aortic valve replacement tavr leads to lower device success compared to tavr in native stenosis |
| topic | valve in valve aortic replacement bioprosthetic valve degeneration transcatheter aortic replacement device success bioprosthetic valve failure |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1465409/full |
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