Dvir, DannyWebb, JohnBrecker, StephenBleiziffer, SabineHildick-Smith, DavidColombo, AntonioDescoutures, FleurHengstenberg, ChristianMoat, Neil EBekeredjian, RaffiNapodano, MassimoTesta, LucaLefevre, ThierryGuetta, VictorNissen, HenrikHernández, José-MaríaRoy, DavidTeles, Rui C.Segev, AmitDumonteil, NicolasFiorina, ClaudiaGotzmann, MichaelTchetche, DidierAbdel-Wahab, MohamedMarco, Federico deBaumbach, AndreasLaborde, Jean-ClaudeKornowski, Ran2013-08-072013-08-072012-11-06Dvir D, Webb J, Brecker S, Bleiziffer S, Hildick-Smith D, Colombo A, et al. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: Results from the global valve-in-valve registry. Circulation. 2012; 126(19):2335-23440009-7322http://hdl.handle.net/10668/1270Journal Article."Comment in Valvular disease: Aortic valve-in-valve replacement. [Nat Rev Cardiol. 2012] Valve in valve: another milestone for transcatheter valve therapy. [Circulation. 2012]". (Nota tomada de PubMed)BACKGROUND Transcatheter aortic valve-in-valve implantation is an emerging therapeutic alternative for patients with a failed surgical bioprosthesis and may obviate the need for reoperation. We evaluated the clinical results of this technique using a large, worldwide registry. METHODS AND RESULTS The Global Valve-in-Valve Registry included 202 patients with degenerated bioprosthetic valves (aged 77.7±10.4 years; 52.5% men) from 38 cardiac centers. Bioprosthesis mode of failure was stenosis (n=85; 42%), regurgitation (n=68; 34%), or combined stenosis and regurgitation (n=49; 24%). Implanted devices included CoreValve (n=124) and Edwards SAPIEN (n=78). Procedural success was achieved in 93.1% of cases. Adverse procedural outcomes included initial device malposition in 15.3% of cases and ostial coronary obstruction in 3.5%. After the procedure, valve maximum/mean gradients were 28.4±14.1/15.9±8.6 mm Hg, and 95% of patients had ≤+1 degree of aortic regurgitation. At 30-day follow-up, all-cause mortality was 8.4%, and 84.1% of patients were at New York Heart Association functional class I/II. One-year follow-up was obtained in 87 patients, with 85.8% survival of treated patients. CONCLUSIONS The valve-in-valve procedure is clinically effective in the vast majority of patients with degenerated bioprosthetic valves. Safety and efficacy concerns include device malposition, ostial coronary obstruction, and high gradients after the procedure.enInsuficiencia de la Válvula AórticaEstenosis de la Válvula AórticaEnfermedad de la Arteria CoronariaImplantación de Prótesis de Válvulas CardíacasPrótesis Valvulares CardíacasCateterismo Venoso CentralResultado del TratamientoBioprosthesisTranscatheter aortic valve implantationValve-in-valveMedical Subject Headings::Diseases::Cardiovascular Diseases::Heart Diseases::Heart Valve Diseases::Aortic Valve InsufficiencyMedical Subject Headings::Diseases::Cardiovascular Diseases::Heart Diseases::Heart Valve Diseases::Aortic Valve StenosisMedical Subject Headings::Diseases::Cardiovascular Diseases::Vascular Diseases::Arterial Occlusive Diseases::Arteriosclerosis::Coronary Artery DiseaseMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Cardiac Surgical ProceduresMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Equipment and Supplies::Prostheses and Implants::Heart Valve ProsthesisMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Vascular Surgical Procedures::Endovascular Procedures::Catheterization, Central VenousMedical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::HumansMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment OutcomeMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Equipment and Supplies::Prostheses and Implants::Bioprosthesisresearch article23052028open access10.1161/CIRCULATIONAHA.112.1045051524-4539