CUI Hongzhan , ZHANG Hang , WANG Huajun , AN Jinghui , LIU Su , MA Qianli , SHI Fengwu
  • Department of Cardiac Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, P. R. China;
SHI Fengwu, Email: shifengwu65@163.com
Elderly; transcatheter aortic valve replacement; valve-in-valve; paravalvular regurgitation; conduction block; mid-to-long-term follow-up
10.7507/1007-4848.202606040
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Objective To investigate the mid-to-long-term clinical outcomes of elderly patients undergoing simultaneous valve-in-valve (ViV) implantation during transcatheter aortic valve replacement (TAVR), and to summarize relevant experience. Methods Clinical data of elderly patients who received TAVR at the Second Hospital of Hebei Medical University between January 2017 and January 2023 were collected. Patients were divided into a simple TAVR group and a ViV group according to whether concomitant ViV implantation was performed intraoperatively. Perioperative, postoperative 1-year and 3-year all-cause mortality, complications and echocardiographic hemodynamic parameters were compared between the two groups. A paired design was adopted for the 1-year and 3-year follow-up in the ViV group, and only patients with complete follow-up data at both time points were included in the study. The loss-to-follow-up rate was calculated, and follow-up bias was adjusted. Results A total of 428 patients were enrolled, including 407 patients in the simple TAVR group (298 males and 109 females), with a mean age of (67.6±6.3) years; and 21 patients in the ViV group (13 males and 8 females), with a mean age of (68.3±6.3) years. The overall 1-year follow-up rate was 91.8%, and the 3-year rate was 88.1%. In the simple TAVR group, 372 patients completed 1-year follow-up and 356 completed 3-year follow-up, and the cumulative loss-to-follow-up rate was 12.5% over 3 years. All patients in the ViV group finished both 1-year and 3-year follow-up. There were no statistically significant differences between the two groups in all-cause mortality at 1 and 3 years after surgery, distribution of paravalvular leakage (PVL) grade, permanent pacemaker implantation, heart failure readmission, mitral valve dysfunction, valve thrombosis or stroke incidence (P>0.05). No significant intergroup differences were observed in mean aortic transvalvular gradient, effective orifice area and left ventricular ejection fraction at each follow-up time point (P>0.05). Intragroup paired comparisons within the ViV group also showed no statistically significant differences in the all-cause mortality, complications or echocardiographic parameters between 1-year and 3-year follow-up (P>0.05). The incidence of intraoperative simultaneous ViV implantation in our center was 4.9%. The predisposing factors were, in descending order, isolated severe aortic regurgitation, bicuspid aortic valve and asymmetric annular calcification. The proportion of ViV implantation using the first-generation delivery system was markedly higher than that using the second-generation retrievable delivery system (76.2% vs. 23.8%). Conclusion Simultaneous ViV implantation during TAVR is a feasible technique for intraoperative management of PVL, which can significantly reduce the severity of PVL. It yields reliable mid-to-long-term outcomes in terms of all-cause mortality, conduction block, heart failure, stroke and valvular hemodynamic performance.

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