Comparison of Latest Generation Intra- and Supra-Annular Self-Expanding Transcatheter Heart Valves for Aortic Valve-in-Valve Procedures.

BACKGROUND

Valve-in-valve (ViV) procedures are an established therapy. Self-expanding (SE) supra-annular transcatheter heart valves (THV) achieve superior hemodynamics compared to balloon-expandable (BE) intra-annular THV, but influence of stent design versus valve position remains unclear.

AIMS: This study compares SE intra- and supra-annular THV for aortic ViV procedures to further elucidate this topic.

METHODS

From 05/2022 to 11/2023, 10 patients underwent ViV procedures with the SE intra-annular Navitor valve. A control group of 22 patients treated with the SE supra-annular Evolut R/PRO valve during the same period was retrieved from our database. Data were retrospectively analyzed according to updated valve academic research consortium (VARC) 3 definitions. A subgroup analysis matched patients for true internal diameter (ID) and body mass index (BMI).

RESULTS

Postprocedural transvalvular gradients were similar between groups. No differences in rates of significant paravalvular leakage (PVL) were seen (p = 0.131). No all-cause mortality occurred in either group. Device success (study group, Navitor: 70 [7] vs. control group, Evolut: 90.1 [20]; p = 0.293), early safety (90 [9] vs. 86.4 [19]; p = 1.000), permanent pacemaker implantation (PPI) (0 [0] vs. 9.1 [2]; p = 1.000), and stroke (0 [0] vs. 4.5 [1]; p = 1.000) were similar between groups. Procedure time was shorter for the study group (65.8 ± 27.9 min vs. 145.7 ± 51.3 min; p < 0.001). After matching for True ID and BMI these results persisted.

CONCLUSION

Intra- and supra-annular THV showed similar clinical and hemodynamic outcomes in aortic ViV procedures. These findings highlight the applicability of SE intra-annular THV for aortic ViV procedures.