Study examines survival following repair of failed bioprosthetic aortic valves

In an analysis of about 460 patients with failed bioprosthetic aortic valves who underwent transcatheter valve-in-valve implantation, overall survival at one year was 83 percent, with survival associated with surgical valve size and mechanism of failure, according to a study in the July 9 issue of JAMA.

Surgical aortic valve replacements increasingly use bioprosthesis (composed of biological tissue) rather than mechanical valves. Owing to a considerable shift toward bioprosthesis implantation, it is expected that there will be an increase in the number of patients with degeneration of these types of valves. Treatment of patients with failed bioprostheses is a clinical challenge; although reoperation is considered the standard of care, these patients are frequently elderly and have other medical conditions, and repeat cardiac surgery can pose significant illness and risk of death. Transcatheter aortic valve-in-valve implantation is a less invasive approach, however a comprehensive evaluation of survival after the procedure has not previously been performed, according to background information in the article.

Danny Dvir, M.D., of St. Paul's Hospital, Vancouver, Canada, and colleagues evaluated survival of 459 patients after valve-in-valve implantation inside failed surgical bioprosthetic valves using a multinational registry. The patients (average age, 78 years) underwent implantation between 2007 and May 2013 at 55 centers.

Reasons for bioprosthesis failure were stenosis (narrowing of the valve opening; 39.4 percent), regurgitation (backflow of blood through the orifice of the valve due to imperfect closing; 30.3 percent), and combined stenosis and regurgitation (30.3 percent). The overall 1-year survival rate was 83.2 percent.

Patients in the stenosis group had worse 1-year survival (76.6 percent) in comparison with the regurgitation group (91.2 percent) and the combined group (83.9 percent). Similarly, with small valves (≤ 21 mm) had worse 1-year survival (74.8 percent) compared with larger valves.

"Thorough assessment of candidates for valve-in-valve implantation is a key step to obtain optimal results. The current analysis highlights the need for meticulous evaluation of bioprosthesis mechanism of failure before attempting a valve-in-valve procedure," the authors write.

More information: DOI: 10.1001/jama.2014.7246

add to favorites email to friend print save as pdf

Related Stories

TAVI is safe alternative to redo cardiac surgery

Sep 02, 2013

TAVI is a safe alternative to redo cardiac surgery for failing bioprosthetic valves, according to research presented at the ESC Congress today by Dr. Spyridon Katsanos from the Netherlands. The findings suggest that transcatheter ...

Study compares heart valve systems

Mar 30, 2014

Among patients undergoing aortic valve replacement using a catheter tube, a comparison of two types of heart valve technologies, balloon-expandable or self-expandable valve systems, found a greater rate of device success ...

Recommended for you

Real-time volume imaging of hearts

13 hours ago

A new ultrasound system from Siemens enables doctors to carry out heart examinations through the esophagus for the first time. The system supplies 3D images of the heart as well as additional real-time information ...

Post-PCI bleeding rates vary widely across hospitals

Nov 27, 2014

(HealthDay)—Patient case-mix and procedural factors may contribute to wide variation in the hospital rates of bleeding after percutaneous coronary intervention (PCI), according to research published online ...

Most seniors eligible for statin Rx under new guidelines

Nov 25, 2014

(HealthDay)—Most older Americans qualify for treatment with statins under new guidelines for the treatment of blood cholesterol released late last year by the American College of Cardiology and the American ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.