TAVR for failing surgical valves: Lessons learned from new 5-year data
TAVR for failing surgical valves: Lessons learned from new 5-year data.
Key Points from PARTNER 3 Aortic Valve-in-Valve Study
Conference: Cardiovascular Research Technologies (CRT) March 2025.
Presenter: S. Chris Malaisrie, MD
1. Five-Year Outcomes of Aortic Valve-in-Valve (VIV) TAVR
• The study analyzed 100 low- and intermediate-risk patients who underwent transfemoral TAVR using the Edwards Lifesciences Sapien 3 valve due to failing bioprosthetic valves.
• The five-year mortality rate was 11%, which is considered favorable.
• Current U.S. guidelines only approve VIV procedures for high-risk patients, making these findings crucial for expanding treatment in lower-risk groups.
2. Implications for Lifetime Valve Management
• Many patients undergoing VIV TAVR were initially in their 50s at the time of their first aortic valve replacement, raising concerns about long-term treatment strategies.
• The findings support a Surgical Aortic Valve Replacement (SAVR) first approach in younger patients, followed by TAVR as a second intervention to maintain future treatment options.
3. Durability and Hemodynamics of VIV TAVR
• At five years, mean pressure gradients remained at 17-19 mmHg, slightly higher than those observed in native aortic stenosis TAVR cases.
• Optimization strategies for better outcomes:
• Performing aortic root enlargement during initial surgery to allow for larger future valves.
• Ensuring proper valve sizing and positioning to prevent complications like leaflet pinwheeling and malalignment.
• Creating a larger annulus during surgery to accommodate potential second or third VIV procedures in the future.
These findings highlight the viability of VIV TAVR in lower-risk patients and emphasize the importance of procedural planning for long-term valve management.
( Bioprosthetic (tissue) valves are the primary candidates for valve-in-valve (VIV) TAVR because they can degenerate over time, whereas mechanical valves are designed for durability.
If a mechanical valve fails, the standard approach is re-do surgical aortic valve replacement (SAVR), rather than TAVR).
