Patient characteristics and long-term outcomes in patients undergoing transcatheter aortic valve implantation in a failed surgical prosthesis versus in a native valve

Abstract Background Valve-in-valve transcatheter aortic valve implantation (TAVI) is an increasingly used treatment for failed surgical aortic prosthesis, but data from clinical practice are limited. Purpose We examined patient characteristics and outcomes of patients undergoing TAVI in a surgical valve compared with patients undergoing TAVI in a native valve. Methods Patients undergoing TAVI from January 1, 2008, to December 31, 2020, were identified using Danish nationwide registries. Results In total, 6070 patients undergoing TAVI were identified; 247 (4%) patients had a history of SAVR (The valve-in-valve cohort). Patients with valve-in-valve-TAVI were younger but had a greater burden of cardiovascular comorbidities compared with patients with native-valve-TAVI. The cumulative 30-day risk of death was 2.4% (95% CI: 1.0% to 5.0%) in patients with valve-in-valve-TAVI and 2.7% (95% CI: 2.3% to 3.1%) in patients with native-valve-TAVI (Figure 1A). Correspondingly, the cumulative 5-year risk of death was 42.5% (95% CI: 34.2% to 50.6%) and 44.8% (95% CI: 43.2% to 46.4%), respectively. Within 30 days post-procedure, 11 (0.2%) patients with valve-in-valve-TAVI and 748 (13.8%) patients with native-valve-TAVI, had a pacemaker implantation. In multivariable Cox proportional hazard analysis, patients with valve-in-valve TAVI did not have a significantly different risk of rehospitalization from any cause compared to patients with native valve TAVI at 30 days (HR 0.80 [95% CI 0.58-1.10]) and at 5 years (HR 0.85 [95% CI 0.73-1.00]) (Figure 1B). Furthermore, in adjusted analysis, valve-in-valve-TAVI was not associated with significantly different risk of death at 30 days (Hazard ratio (HR)= 0.98, 95% CI 0.43-2.22) and 5 years (HR=0.81, 95% CI 0.64-1.03) compared with native-valve-TAVI. Conclusions TAVI in a failed surgical aortic prosthesis as compared to TAVI in a native valve, was not associated with significantly different short- and long-term mortality. Although these findings to some extent reflect thorough patient selection, valve-in-valve-TAVI appears to be a safe procedure.