Transcatheter valve-in-valve replacement of degenerated bioprosthetic aortic valves: A single Australian Centre experience

•Patients with degenerated surgical bioprosthetic valves may be at high risk for further surgery.•Twelve patients had valve-in-valve implants for degenerated bioprosthetic aortic valves.•There were no periprocedural deaths, myocardial infarcts, neurological events or major vascular complications.•Two died after 3.6 and 4.5 years. Median survival for those remaining has exceeded 19 months.•The survivors are stable with NYHA functional class I/II status although prosthesis-patient mismatch and prosthetic stenosis are a concern.•Transcatheter valve-in-valve implantation is a safe and effective treatment for patients with failed bioprosthetic aortic valves for whom reoperation is considered to be unduly hazardous.

BackgroundPatients with degenerated surgical bioprosthetic valves may be at high risk for further surgery because of age, comorbidities and the difficulties of repeat procedures. Percutaneous valve-in-valve implantation offers what may be a simpler and safer procedure.MethodsFrom May 2009 to March 2014 at the Prince Charles Hospital 1625 patients underwent surgical aortic valve replacement while 262 underwent transcatheter aortic valve implantation. Twelve patients had valve-in-valve implants for degenerated bioprosthetic aortic valves.ResultsThese implants were deployed successfully without major valvular or paravalvular regurgitation. There were no periprocedural deaths, myocardial infarcts, neurological events or major vascular complications. Two patients died after 1624 and 1319 days. Median survival for the remainder is 581 days; they are stable with New York Heart Association class I/II functional status although 4 have a degree of patient-prosthesis mismatch, one has moderate aortic regurgitation and one required surgery for a late aortic dissection.ConclusionTranscatheter valve-in-valve implantation is safe and effective treatment for patients with failed bioprosthetic aortic valves for whom reoperation is considered to be hazardous.