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Transcatheter Aortic and MitralĀ Valve-in-Valve Implantation for FailedĀ Surgical Bioprosthetic Valves: An 8-Year Single-Center Experience.
- Source :
-
JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2015 Nov; Vol. 8 (13), pp. 1735-44. Date of Electronic Publication: 2015 Oct 14. - Publication Year :
- 2015
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Abstract
- Objectives: We report our 8-year experience in transcatheter aortic and mitral valve-in-valve (VinV) implantation.<br />Background: Feasibility and good early outcomes associated with transcatheter aortic and mitral VinV implantation into failed surgical bioprostheses have been confirmed, but the mid-term and long-term outcomes of transcatheter aortic and mitral VinV is unknown.<br />Methods: A total of 73 patients with aortic (n = 42) and mitral (n = 31) bioprosthetic valve dysfunction underwent transcatheter VinV implantation between April 2007 and December 2013. Edwards balloon-expandable transcatheter valves (Edwards Lifesciences Inc., Irvine, California) were used. Median follow-up was 2.52 years with a maximum of 8 years.<br />Results: Seventy-two patients (mean age 79.7 ± 9.4 years, 32 women) underwent successful VinV implantation (success rate 98.6%). At 30 days, all-cause mortality was 1.4%, disabling stroke 1.4%, life-threatening bleeding 4.1%, acute kidney injury requiring hemodialysis 2.7%, and coronary artery obstruction requiring intervention 1.4%. No patient had greater than mild paravalvular leak. Estimated survival rates were 88.9%, 79.5%, 69.8%, 61.9%, and 40.5% at 1, 2, 3, 4, and 5 years, respectively. The small surgical valve size (19 and 21 mm) was an independent risk factor for reduced survival in aortic VinV patients. At 2-year follow-up, 82.8% of aortic and 100% of mitral VinV patients were in New York Heart Association functional class I or II.<br />Conclusions: Transcatheter VinV for failed surgical bioprostheses can be performed safely with a high success rate and minimal early mortality and morbidity. Transcatheter VinV provides encouraging mid-term clinical outcomes in this high-risk elderly cohort of patients. Transcatheter VinV is an acceptable alternative therapy for failed aortic or mitral bioprostheses in selected high-risk patients.<br /> (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Aortic Valve physiopathology
British Columbia
Feasibility Studies
Female
Heart Valve Diseases diagnosis
Heart Valve Diseases mortality
Heart Valve Diseases physiopathology
Heart Valve Diseases surgery
Humans
Kaplan-Meier Estimate
Male
Mitral Valve physiopathology
Patient Selection
Prosthesis Design
Recovery of Function
Retreatment
Risk Factors
Time Factors
Treatment Failure
Aortic Valve surgery
Bioprosthesis
Cardiac Catheterization adverse effects
Cardiac Catheterization instrumentation
Cardiac Catheterization methods
Cardiac Catheterization mortality
Heart Valve Diseases therapy
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation adverse effects
Heart Valve Prosthesis Implantation instrumentation
Heart Valve Prosthesis Implantation methods
Heart Valve Prosthesis Implantation mortality
Mitral Valve surgery
Prosthesis Failure
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7605
- Volume :
- 8
- Issue :
- 13
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 26476608
- Full Text :
- https://doi.org/10.1016/j.jcin.2015.08.012