Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease

Frontiers in Cardiovascular Medicine

article

Mariana Pezzute Lopes¹  Vitor Emer Egypto Rosa¹  José Honório Palma¹  Marcelo Luiz Campos Vieira¹  Joao Ricardo Cordeiro Fernandes¹  Antonio de Santis¹  Guilherme Sobreira Spina¹  Rafael de Jesus Fonseca¹  Mauricio F. de Sá Marchi¹  Alexandre Abizaid¹  Fábio Sândoli de Brito¹  Flavio Tarasoutchi¹  Roney Orismar Sampaio¹  Henrique Barbosa Ribeiro¹ 

[1] Heart Institute (InCor) Clinical Hospital, University of Sáo Paulo

关键词: heart valve prosthesis;    rheumatic heart disease;    bioprosthesis;    mitral valve;    aortic valve;    transcatheter valve-in-valve;    transapical access;    transeptal access;   

DOI  :  10.3389/fcvm.2021.694339

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background: Bioprosthetic heart valve has limited durability and lower long-term performance especially in rheumatic heart disease (RHD) patients that are often subject to multiple redo operations. Minimally invasive procedures, such as transcatheter valve-in-valve (ViV) implantation, may offer an attractive alternative, although data is lacking. The aim of this study was to evaluate the baseline characteristics and clinical outcomes in rheumatic vs. non-rheumatic patients undergoing ViV procedures for severe bioprosthetic valve dysfunction. Methods: Single center, prospective study, including consecutive patients undergoing transcatheter ViV implantation in aortic, mitral and tricuspid position, from May 2015 to September 2020. RHD was defined according to clinical history, previous echocardiographic and surgical findings. Results: Among 106 patients included, 69 had rheumatic etiology and 37 were non-rheumatic. Rheumatic patients had higher incidence of female sex (73.9 vs. 43.2%, respectively; p = 0.004), atrial fibrillation (82.6 vs. 45.9%, respectively; p < 0.001), and 2 or more prior surgeries (68.1 vs. 32.4%, respectively; p = 0.001). Although, device success was similar between groups (75.4 vs. 89.2% in rheumatic vs. non-rheumatic, respectively; p = 0.148), there was a trend toward higher 30-day mortality rates in the rheumatic patients (21.7 vs. 5.4%, respectively; p = 0.057). Still, at median follow-up of 20.7 [5.1–30.4] months, cumulative mortality was similar between both groups ( p = 0.779). Conclusion: Transcatheter ViV implantation is an acceptable alternative to redo operations in the treatment of patients with RHD and severe bioprosthetic valve dysfunction. Despite similar device success rates, rheumatic patients present higher 30-day mortality rates with good mid-term clinical outcomes. Future studies with a larger number of patients and follow-up are still warranted, to firmly conclude on the role transcatheter ViV procedures in the RHD population.

【 授权许可】

CC BY