Study Shows Feasibility of TAVI With CoreValve to Replace Degenerated Surgically Implanted Aortic Bioprostheses

October 20, 2011—In Circulation: Cardiovascular Interventions, Fleur Descoutures, MD, et al published findings from a study that sought to assess the results of transcatheter aortic valve implantation (TAVI) using the CoreValve system (Medtronic, Inc., Minneapolis, MN) in high-risk patients with degenerated surgically implanted aortic bioprostheses (2011;4:488–494).

As detailed by the investigators, out of 241 patients who underwent TAVI, 10 (4%) had a degenerated surgically implanted aortic bioprosthesis. The approach to access was percutaneous transfemoral in nine patients and surgical transaxillary in one patient. Patients were 75 ± 10 years of age. All were in New York Heart Association classes III or IV and were at high risk for repeated surgery. Seven patients had undergone stenting, two had no stents, and one had a homograft surgically implanted aortic bioprosthesis. The failure mode was predominant regurgitation in seven cases and stenosis (aortic valve area, 0.7 ± 0.2 cm²; mean gradient, 58 ± 16 mm Hg) in three. Based on echographic measurements, eight patients received a 26-mm CoreValve device, and two received a 29-mm CoreValve device.

The procedural success rate was 100%. There was one in-hospital death, one stroke with moderate sequelae, and one pacemaker implantation. There were no other adverse events at 30 days. The mean postimplantation transprosthetic gradient was 13 ± 7 mm Hg; periprosthetic regurgitation was absent or trivial in nine cases and grade 2 in one case. After a median follow-up of 5 months, there were no additional adverse events. All but one of the hospital survivors were in New York Heart Association classes I or II.

The investigators concluded that the results suggest that transarterial CoreValve implantation in degenerated surgically implanted aortic bioprostheses is feasible and may lead to hemodynamic and clinical improvement in patients who are poor candidates for repeated surgery, pending confirmation in larger series with longer follow-up.