TAVI offers an attractive option for patients with failed bioprosthesis and high operative risk (valve-in-valve concept).

The objective of this study was to analyze outcomes of patients with failed aortic bioprosthesis undergoing transcatheter aortic valve-in-valve implantation.

From January 2012 to January 2015, 15 patients with degenerated aortic valve bioprosthesis underwent transcatheter aortic valve-in-valve implantation in our institution. Mean patient age was 82±6 years. Mean logistic Euroscore was 36±16% and mean STS score was 16±14%. The mean follow-up was 260±316 days.

The failing bioprosthesis were Cryolife O’brien in 5 patients, Carpentier Edwards in 5 patients, Medtronic mosaic in 4 patients and Mitroflow in 1 patient. Bioprosthesis mode of failure was stenosis (n=6), regurgitation (n=5), or combined stenosis and regurgitation (n=4). The mean degenerative time was 11.15±6.1 years.

Implanted devices included Medtronic CoreValve (n=6) and Edwards SAPIEN (n=9). Successful implantation of a transcatheter aortic valve-in-valve with the patient leaving the catheterization laboratory alive was achieved in all patients. Adverse procedural outcomes included initial device malposition in 3 cases requiring a second valve, retroperitoneal hematoma in 1 patient, permanent pacemaker in 1 patient, Stroke in 1 patient and acute renal failure in 1 patient. The mean transvalvular gradient passed from 48.7±17.63 to 18.32±9.3mmHg in stenotic degenerated bioprosthesis. No significant aortic regurgitation was observed post-implantation. During hospitalization, 1 patient developed myocardial infarction. The medium inhospital stay was 13.4±7.7 days. During later follow-up, there was no death, no myocardial infarction and no stroke or TIA. 2 patients were hospitalized for heart failure.

Transcatheter aortic valve-in-valve implantation seems to be feasible and safe in both stenotic and regurgitant degenerative bioprosthesis.