Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) was found to be safer than native valve (NV) TAVR, according to research presented by E. Murat Tuzcu, MD, FACC on March 18 at ACC.17 in Washington, DC. According to the study, ViV TAVR could be a safe and effective option for patients with failed surgical aortic valve replacement (SAVR).

Study investigators compared 757 ViV TAVR patients and 28,895 NV TAVR patients within the NCDR STS/ACC TVT registry – enrolled between November 2011 to September 2015 – who had ≥one-year outcome data linked to Medicare administrative claims. The ViV TAVR patient group had a median age of 79 years and 39 percent were women, while the NV TAVR patient group had a median age of 84 years and 46 percent were women.

In the ViV TAVR group compared with the NV TAVR group, in-hospital mortality was lower (2.3 percent vs 4.1 percent) as well as one-year mortality (13.3 percent vs 23.1 percent). Similarly, the rates of stroke were lower with ViV TAVR both in-hospital (0.04 percent vs 2.1 percent) and at one year (2.0 percent vs 4.3 percent). Post-TAVR echo found ViV TAVR patients had a higher mean gradient than NV TAVR patients (17 vs. 8 mm Hg, p <0.001). Additionally, the mean gradient was highest when SAVR failure was due to aortic stenosis and lowest for aortic regurgitation (19 vs 12 mm Hg, p < 0.001).

Previously, NV TAVR was shown to have similar outcomes with SAVR in high and intermediate risk patients. As such, the authors suggest that for a patient with failed SAVR, who are "frequently at high risk for surgery, valve in valve (ViV) TAVR promise[s] a less risky solution."

Keywords: ACC17, ACC Annual Scientific Session, Aged, 80 and over, Aorta, Aortic Valve, Aortic Valve Stenosis, Aortic Valve Insufficiency, Bioprosthesis, Heart Failure, Heart Valve Diseases, Heart Valve Prosthesis, Medicare, Prosthesis Failure, Registries, Stroke, Transcatheter Aortic Valve Replacement, Treatment Outcome, Registries, STS/ACC TVT Registry

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