Transcatheter valve-in-valve implantation for degenerated stentless aortic bioroots

Davut Cekmecelioglu; Ourania Preventza; Kathryn G Dougherty; Subhasis Chatterjee; Susan Y Green; Guilherme V Silva; Jose G Díez; Joseph S Coselli

doi:10.21037/acs-2021-tviv-124

Transcatheter valve-in-valve implantation for degenerated stentless aortic bioroots

Ann Cardiothorac Surg. 2021 Sep;10(5):641-650. doi: 10.21037/acs-2021-tviv-124.

Authors

Davut Cekmecelioglu^{1

2}, Ourania Preventza^{1

2}, Kathryn G Dougherty², Subhasis Chatterjee^{1

2

3}, Susan Y Green^{1

4}, Guilherme V Silva⁵, Jose G Díez^{5

6}, Joseph S Coselli^{1

2}

Affiliations

¹ Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
² Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA.
³ Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College Medicine, Houston, Texas, USA.
⁴ Office of Surgical Research, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
⁵ Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
⁶ Department of Cardiology, Texas Heart Institute, Houston Texas, USA.

Abstract

Background: Open surgical repair of a failed valve-sparing aortic root replacement (VSARR) or stentless bioroot aortic root replacement (bio-ARR) entails significant operative risks. Whether valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is feasible in patients with a previous VSARR or stentless bio-ARR remains unclear, given lingering concerns about the ill-defined aortic annulus in these patients and the potential for coronary obstruction. We present our experience with patients who had a previous VSARR or stentless bio-ARR and underwent ViV-TAVR to repair a degenerated aortic valve with combined valvular disease, aortic insufficiency and aortic stenosis.

Methods: In this retrospective data review, we identified and analyzed consecutive patients with a previous VSARR or stentless bio-ARR who underwent ViV-TAVR between December 1, 2014 and August 31, 2019.

Results: ViV-TAVR was performed in twelve high-risk patients with previous VSARR or bio-ARR during the study period. Of these, seven received Medtronic Freestyle porcine stentless bioprosthetic aortic roots, three received homograft aortic roots, one underwent a Ross procedure and one underwent VSARR. ViV-TAVR restored satisfactory valve function in all patients, and technical success was 100%. No patient had more than mild regurgitation after implantation. No thirty-day mortality was seen. One patient had major bleeding after transapical access, one patient had a transient ischemic stroke, and one patient needed permanent pacemaker implantation. At a median last follow-up of 21.5 months (interquartile range, 9.0-69.0 months), all patients remained alive and had satisfactory valve function.

Conclusions: In this study, ViV-TAVR was a clinically effective option for treating patients with a failed stentless bio-ARR or previous VSARR. Short-term and intermediate-term results after these procedures were favorable. These findings may have important implications for treating high-risk patients with structural aortic root deterioration and call for better transcatheter heart valves that are suitable for treating aortic insufficiency.

Keywords: Stentless aortic valve; aortic root replacement (ARR); stentless aortic root; transcatheter aortic valve replacement (TAVR); valve-in-valve (ViV).