de Freitas Campos Guimarães, LeonardoUrena, MarinaWijeysundera, Harindra CMunoz-Garcia, AntonioSerra, VicençBenitez, Luis MAuffret, VincentCheema, Asim NAmat-Santos, Ignacio JFisher, QuentinHimbert, DominiqueGarcia Del Blanco, BrunoDager, AntonioLe Breton, HervéParadis, Jean-MichelDumont, EricPibarot, PhilippeRodés-Cabau, Josep2023-01-252023-01-252018http://hdl.handle.net/10668/13126Data 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.enbioprosthesisechocardiographyhemodynamicsstandard of caretranscatheter aortic valve replacementAgedAged, 80 and overAortic ValveAortic Valve InsufficiencyAortic Valve StenosisEchocardiography, Doppler, ColorFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamicsHumansMaleProsthesis DesignProsthesis FailureRecovery of FunctionReoperationRetrospective StudiesRisk FactorsSeverity of Illness IndexTime FactorsTranscatheter Aortic Valve ReplacementTreatment Outcomeresearch article30354588open access10.1161/CIRCINTERVENTIONS.118.0070381941-7632https://www.ahajournals.org/doi/pdf/10.1161/CIRCINTERVENTIONS.118.007038