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Hemodynamic Follow-Up after Valve-in-Valve TAVR for Failed Aortic Bioprosthesis
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  • Manuel Wilbring,
  • Utz Kappert,
  • Haussig S,
  • Winata, J,
  • Klaus Matschke,
  • Mangner N,
  • Sebastian Arzt,
  • Alexiou K
Manuel Wilbring
Herzzentrum Dresden GmbH Universitatsklinik an der Technischen Universitat Dresden

Corresponding Author:manuel.wilbring@gmail.com

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Utz Kappert
Herzzentrum Dresden GmbH Universitatsklinik an der Technischen Universitat Dresden
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Haussig S
Herzzentrum Dresden GmbH Universitatsklinik an der Technischen Universitat Dresden
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Winata, J
Herzzentrum Dresden GmbH Universitatsklinik an der Technischen Universitat Dresden
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Klaus Matschke
Herzzentrum Dresden GmbH Universitatsklinik an der Technischen Universitat Dresden
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Mangner N
Herzzentrum Dresden GmbH Universitatsklinik an der Technischen Universitat Dresden
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Sebastian Arzt
Herzzentrum Dresden GmbH Universitatsklinik an der Technischen Universitat Dresden
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Alexiou K
Herzzentrum Dresden GmbH Universitatsklinik an der Technischen Universitat Dresden
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Abstract

Background VIV-TAVR is established and provides good initial clinical and hemodynamic outcomes. Lacking long-term durability data baffle the expand to lower risk patients. For those purposes, the present study adds a hemodynamic 3-years follow-up. Methods A total of 77 patients underwent VIV-TAVR for failing aortic bioprosthesis during a 7-years period. Predominant mode of failure was stenosis in 87.0%. Patients had a mean age of 79.4±5.8 years and a mean logistic EuroSCORE of 30.8±15.7%. The STS-PROM averaged 5.79±2.63%. Clinical results and hemodynamic outcomes are reported for 30-days, 1-, 2- and 3-years. Completeness of follow-up was 100% with 44 patients at risk after 3-years. Follow-up ranged up to 7.1 years. Results Majority of the surgical valves were stented (94.8%) with a mean labeled size of 23.1±2.3mm and true-ID of 20.4±2.6mm. A true-ID ≤21mm had 58.4% of the patients. Self-expanding valves were implanted in 68.8% (mean labeled size 24.1±1.8mm) and balloon-expanded in 31.2% (mean size 24.1±1.8mm). No patient died intraoperatively. Hospital mortality was 1.3% and three-years survival 57.1%. All patients experienced an initial significant dPmean-reduction to 16.8±7.1mmHg. After 3-years mean dPmean raised to 26.0±12.2mmHg. This observation was independent from true-ID or type of TAVR-prosthesis. Patients with a true-ID ≤21mm had a higher initial (18.3±5.3mmHg vs. 14.9±7.1mmHg; p=0.005) and dPmean after 1-year (29.2±8.2mmHg vs. 13.0±6.7mmHg; p=0.004). There were no significant differences in survival. Conclusions VIV-TAVR is safe and effective in the early period. In surgical valves with a true-ID≤21mm inferior hemodynamic and survival outcomes must be expected. Nonetheless, also patients with larger true-ID’s showed steadily increasing transvalvular gradients. This raises concern about durability.
20 Jul 2022Submitted to Journal of Cardiac Surgery
20 Jul 2022Submission Checks Completed
20 Jul 2022Assigned to Editor
04 Aug 2022Reviewer(s) Assigned
25 Aug 2022Review(s) Completed, Editorial Evaluation Pending
25 Aug 2022Editorial Decision: Revise Major
01 Sep 20221st Revision Received
01 Sep 2022Submission Checks Completed
01 Sep 2022Assigned to Editor
30 Sep 2022Review(s) Completed, Editorial Evaluation Pending
05 Oct 2022Editorial Decision: Accept
23 Oct 2022Published in Journal of Cardiac Surgery. 10.1111/jocs.17048