ObjectiveTo summarize the results and clinical experience of transcatheter valve-in-valve implantation using domestic self-expanding valve in patients with aortic degenerated bio-prosthesis. MethodsFrom January 2019 to April 2023, the patients who underwent transcatheter valve-in-valve surgery in the Department of Cardiac Surgery of Tianjin Chest Hospital due to surgical bio-prosthesis failure were included. Characteristics of valves, perioperative complications, and hemodynamic manifestations during the early postoperative and follow-up period were analyzed. ResultsA total of 24 patients were enrolled, including 14 males and 10 females with an average age of 68.17±7.72 years, and the average interval between the two operations was 10.48±4.09 years. All patients were successfully discharged without complications such as coronary artery obstruction and pacemaker implantation, and the average transvalvular pressure gradient was 16.39±6.52 mm Hg before discharge. During the median follow-up time of 16 months, the left ventricular diastolic inner diameter and ejection fraction were continuously improved. ConclusionTranscatheter valve-in-valve using domestic self-expanding valves is safe and feasible to treat aortic bioprosthetic valve failure. Sound patient selection and surgical strategies are critical to achieve good hemodynamics.
Objective To summarize the clinical experience and mid-term outcomes of transcatheter aortic valve implantation valve-in-valve (TAVI-ViV) for failed surgical bioprostheses in the aortic position. Methods Patients who underwent TAVI-ViV procedures at Tianjin University Chest Hospital between January 2019 and January 2025 were consecutively enrolled. Baseline characteristics, procedural details, and postoperative hemodynamic performance were collected and analyzed. Early postoperative and follow-up valve hemodynamics were evaluated, and surgical experiences were summarized. The primary endpoint was all-cause mortality, and the secondary endpoint was severe prosthetic valve stenosis. Results A total of 45 patients were included, with a mean age of (68.38±7.72) years and an average interval between surgeries of (11.00±3.67) years. The Society of Thoracic Surgeons (STS) score was 6.80% (4.29%, 8.21%). The procedural success rate was 97.78% (44/45), with one case aborted due to coronary obstruction. The mean implantation depth was (6.87±3.45) mm, the annular expansion rate ranged from 10% to 40%, and the stent crown compression rate varied from 0% to 42%. The median follow-up duration was 21 months, with 27 patients completing the 2-year follow-up. At 2 years postoperatively, the overall follow-up rate was 92.59% (25/27), and the echocardiographic follow-up rate was 66.67% (18/27). The all-cause mortality rate was 7.41% (2/27). The mean peak aortic valve velocity was 2.96±0.69 m/s, the mean transvalvular gradient was (21.83±10.98) mm Hg, and 3 patients exhibited velocities ≥4 m/s (indicating severe stenosis). The regression analysis showed that the implant depth deviation [β=0.41, SE=0.18, OR=1.51, 95%CI (1.06, 2.30), P=0.024］, the compression rate of the corona [β=2.48, OR=11.93, 95%CI (1.21, 122.40), P=0.034], and the enlargement rate of the annulus [β=1.96, OR=7.13, 95%CI (1.28, 35.50), P=0.026] were the independent predictors of high flow velocity after surgery. Conclusion The optimal implantation depth for TAVI-ViV using a self-expanding valve system is 4 to 5 mm. When the annular expansion rate approaches 10%, hemodynamic performance can be significantly improved. The degree of crown compression in the valve stent is strongly correlated with elevated postoperative transvalvular gradients.
