Long-term outcomes after transcatheter aortic valve implantation in failed bioprosthetic valves

Sabine Bleiziffer, Matheus Simonato, John G. Webb, Josep Rodés-Cabau, Philippe Pibarot, Ran Kornowski, Stephan Windecker, Magdalena Erlebach, Alison Duncan, Moritz Seiffert, Axel Unbehaun, Christian Frerker, Lars Conzelmann, Harindra Wijeysundera, Won Keun Kim, Matteo Montorfano, Azeem Latib, Didier Tchetche, Abdelhakim Allali, Mohamed Abdel-WahabKatia Orvin, Stefan Stortecky, Henrik Nissen, Andreas Holzamer, Marina Urena, Luca Testa, Marco Agrifoglio, Brian Whisenant, Janarthanan Sathananthan, Massimo Napodano, Antonio Landi, Claudia Fiorina, Armin Zittermann, Verena Veulemans, Jan Malte Sinning, Francesco Saia, Stephen Brecker, Patrizia Presbitero, Ole de Backer, Lars Søndergaard, Giuseppe Bruschi, Luis Nombela Franco, Anna Sonia Petronio, Marco Barbanti, Alfredo Cerillo, Konstantinos Spargias, Joachim Schofer, Mauricio Cohen, Antonio Muñoz-Garcia, Ariel Finkelstein, Matti Adam, Vicenç Serra, Rui Campante Teles, Didier Champagnac, Alessandro Iadanza, Piotr Chodor, Holger Eggebrecht, Robert Welsh, Adriano Caixeta, Stefano Salizzoni, Antonio Dager, Vincent Auffret, Asim Cheema, Timm Ubben, Marco Ancona, Tanja Rudolph, Jan Gummert, Elaine Tseng, Stephane Noble, Matjaz Bunc, David Roberts, Malek Kass, Anuj Gupta, Martin B. Leon, Danny Dvir

Research output: Contribution to journalArticlepeer-review

81 Scopus citations


Aims Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There are no data on long-term outcomes after aortic ViV. Our aim was to perform a large-scale assessment of long-term survival and reintervention after aortic ViV. Methods A total of 1006 aortic ViV procedures performed more than 5 years ago [mean age 77.7 ± 9.7 years; 58.8% male; and results median STS-PROM score 7.3% (4.2-12.0)] were included in the analysis. Patients were treated with Medtronic self-expandable valves (CoreValve/Evolut, Medtronic Inc., Minneapolis, MN, USA) (n = 523, 52.0%), Edwards balloon-expandable valves (EBEV, SAPIEN/SAPIEN XT/SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) (n = 435, 43.2%), and other devices (n = 48, 4.8%). Survival was lower at 8 years in patients with small-failed bioprostheses [internal diameter (ID) <_ 20 mm] compared with those with large-failed bioprostheses (ID > 20 mm) (33.2% vs. 40.5%, P = 0.01). Independent correlates for mortality included smaller-failed bioprosthetic valves [hazard ratio (HR) 1.07 (95% confidence interval (CI) 1.02-1.13)], age [HR 1.21 (95% CI 1.01-1.45)], and non-transfemoral access [HR 1.43 (95% CI 1.11-1.84)]. There were 40 reinterventions after ViV. Independent correlates for all-cause reintervention included pre-existing severe prosthesis-patient mismatch [subhazard ratio (SHR) 4.34 (95% CI 1.31-14.39)], device malposition [SHR 3.75 (95% CI 1.36-10.35)], EBEV [SHR 3.34 (95% CI 1.26-8.85)], and age [SHR 0.59 (95% CI 0.44-0.78)]. Conclusions The size of the original failed valve may influence long-term mortality, and the type of the transcatheter valve may influence the need for reintervention after aortic ViV.

Original languageEnglish (US)
Pages (from-to)2731-2742
Number of pages12
JournalEuropean heart journal
Issue number29
StatePublished - Aug 1 2020


  • Aortic valve-in-valve
  • Reintervention
  • SAPIEN valve
  • Severe prosthesis-patient mismatch
  • TAVR

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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