Valve-in-valve transcatheter aortic valve implantation with CoreValve/Evolut R © for degenerated small versus bigger bioprostheses.

ObjectivesWe present our single center experience with Medtronic CoreValve and Evolut R regarding procedural outcome and 3 years follow-up in patients with degenerated bioprostheses. MethodsFrom 1645 patients who underwent transfemoral TAVI at our institution between February 2009 and December 2016, 37 patients with degenerated bioprosthesis were treated with Medtronic CoreValve/Evolut R. All data concerning baseline characteristic, procedural outcomes and follow-up were entered into a dedicated database. ResultsMean age was 83.94.4 years and patients showed an average logistic EuroSCORE of 33.2 +/- 16.7%. Successful ViV deployment was achieved in all cases, a permanent pacemaker was implanted in 16.2%, no periinterventional stroke and no coronary obstruction occurred. Mortality at 30 days was 2.7%, at 1-year follow-up 5.7% and at three years 13.5%. Depending on bioprosthesis size <23mm versus 23mm echocardiographic mean gradients post implantation were significantly higher in the smaller bioprostheses, 22.8 mmHg +/- 9.4 mmHg versus 15.1 +/- 7.1, P=0.013. ConclusionViV-TAVI with CoreValve/R is demonstrated to be safe and effective in terms of no coronary obstruction and very low mortality up to 3 years despite slightly higher mean transprosthetic gradients especially in very small bioprostheses.