Success of TAVR for Failed Aortic Prosthetic Valves

Dr. Danny Dvir MD St Paul’s Hospital, Vancouver British Columbia, Canada Interview with:
Dr. Danny Dvir MD
St Paul’s Hospital, Vancouver
British Columbia, Canada

Medical Research: Who were the patients studied?

Dr. Dvir: The VIVID registry included high-risk patients with failed aortic bioprostheses treated with valve-in-valve. These patients had many comorbidities and high risk scores for early mortality with conventional redo surgery.

Medical Research: What are the treatment options for these patients?

Dr. Dvir: Patients with failed bioprosthetic valves are conventionally treated with redo surgery. Transcatheter valve-in-valve is a less-invasive approach.

Medical Research: What are the main findings of the study?

Dr. Dvir: We have learned from the analyses that clinical outcomes in this high-risk group is satisfactory – 83% 1-year survival after valve-in-valve with very low stroke rate and high functional class. Valve-in-valve seems to be a viable alternative to cardiac surgery in selected high-risk patients with failed surgical valves.

Medical Research: Were any of the findings unexpected?

Dr. Dvir: Patients that had stenosis or small surgical valves had worse outcomes after valve-in-valve. It seems that the characteristics of surgical valves treated with valve-in-valve have most influence on procedural success after valve-in-valve. These are more influential than patient characteristics or the type of transcatheter device used during the procedure.

Medical Research: What should clinicians and patients take away from your report?

Dr. Dvir: Study results have many clinical implications for a wide range of specialties including family practitioners and internal medicine physicians that treat patients with failed bioprosthetic valves, interventional cardiologists and cardiothoracic surgeons. Attempts to implant large bioprostheses during aortic valve surgery may improve outcome, as we see that the surgical valve size has strong impact on the success of valve-in-valve when these valves fail years later.

Medical Research: What future research is expected in the field of valve-in-valve?

Dr. Dvir: Number of cases included in the registry is growing rapidly. We are close to summarizing a large group of mitral valve-in-valve procedures and we have many subanalyses on the way related to limitations of the valve-in-valve approach- which is mainly elevated gradients with prosthetic-patient-mismatch, device malposition, coronary obstruction and many more. There are more to come.