Short-Term Outcomes Following Transcatheter Valve-in-Valve Implantation With Portico or Navitor Valves: The Barts Heart Center Experience.

BACKGROUND

Degeneration of surgical bioprosthetic aortic valves is increasingly common. Redo surgical aortic valve replacement carries substantial morbidity and mortality, particularly in elderly or high-risk patients. Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) has become an established alternative, though data on the performance of self-expanding Portico and Navitor valves remain limited.

METHODS

We retrospectively analyzed 47 consecutive patients who underwent ViV TAVI for severe bioprosthetic aortic valve dysfunction between January 2020 and June 2024 at Barts Heart Center. In-hospital and 30-day outcomes were evaluated using Valve Academic Research Consortium 3 criteria.

RESULTS

The median age was 79 years, and 80.9% had small surgical valves (≤ 23 mm). ViV TAVI with Portico or Navitor valves was successful in 46 cases (97.9%), with no in-hospital mortality or need for emergency cardiac surgery. Technical success was achieved in 89.4% of cases; failures were related to two major vascular complications, two valve-related interventions, and one major cardiac structural complication. At 30 days, device success and safety outcomes were favorable, with no deaths or additional major complications. Two patients (4.3%) experienced ischemic stroke, and one (2.8%) required a new permanent pacemaker. Most patients (97.8%) were in NYHA class I-II. Echocardiography confirmed intended valve performance in 87% of cases, with no moderate or severe aortic regurgitation.

CONCLUSIONS

ViV TAVI with Portico and Navitor valves is a safe and effective option for failed surgical bioprostheses, including small valves, offering excellent short-term outcomes. Further studies are needed to assess long-term durability.