%0 Journal Article
%A de Freitas Campos Guimarães, Leonardo
%A Urena, Marina
%A Wijeysundera, Harindra C
%A Munoz-Garcia, Antonio
%A Serra, Vicenç
%A Benitez, Luis M
%A Auffret, Vincent
%A Cheema, Asim N
%A Amat-Santos, Ignacio J
%A Fisher, Quentin
%A Himbert, Dominique
%A Garcia Del Blanco, Bruno
%A Dager, Antonio
%A Le Breton, Hervé
%A Paradis, Jean-Michel
%A Dumont, Eric
%A Pibarot, Philippe
%A Rodés-Cabau, Josep
%T Long-Term Outcomes After Transcatheter Aortic Valve-in-Valve Replacement.
%D 2018
%U http://hdl.handle.net/10668/13126
%X Data on long-term outcomes after valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) are scarce. The objective of this study was to determine the long-term clinical outcomes and structural valve degeneration (SVD) over time in patients undergoing ViV-TAVR. Consecutive patients undergoing ViV-TAVR in 9 centers between 2009 and 2015 were included. Patients were followed yearly, and clinical and echocardiography data were collected prospectively. SVD was defined as subclinical (increase >10 mm Hg in mean transvalvular gradient+decrease >0.3 cm2 in valve area or new-onset mild or moderate aortic regurgitation) and clinically relevant (increase >20 mm Hg in mean transvalvular gradient+decrease >0.6 cm2 in valve area or new-onset moderate-to-severe aortic regurgitation). A total of 116 patients (mean age, 76±11 years; 64.7% male; mean Society of Thoracic Surgeons score, 8.0±5.1%) were included. Balloon- and self-expandable valves were used in 47.9% and 52.1% of patients, respectively, and 30-day mortality was 6.9%. At a median follow-up of 3 years (range, 2-7 years), 30 patients (25.9%) had died, 20 of them (17.2%) from cardiovascular causes. Average mean transvalvular gradients remained stable up to 5-year follow-up ( P=0.92), but clinically relevant SVD occurred in 3/99 patients (3.0%), and 15/99 patients (15.1%) had subclinical SVD. One patient with SVD had redo ViV-TAVR. About one-fourth of ViV-TAVR recipients had died after a median follow-up of 3 years. Overall valve hemodynamics remained stable over time and clinically relevant SVD was infrequent, but 1 out of 10 patients exhibited some degree of SVD.
%K bioprosthesis
%K echocardiography
%K hemodynamics
%K standard of care
%K transcatheter aortic valve replacement
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