ZHANG Shaopeng 1,2 , TANG Yipeng 1 , BAI Yunpeng 1 , LI Jinghui 1 , CHEN Tongyun 1 , JIANG Nan 1 , CHEN Qingliang 1 , ZHAO Feng 1
  • 1. Department of Cardiovascular Surgery, Tianjin University Chest Hospital, Tianjin Institute of Cardiovascular Diseases, Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care, Tianjin, 300051, P. R. China;
  • 2. Graduate School of Tianjin Medical University, Tianjin, 300051, P. R. China;
CHEN Qingliang, Email: zhaofeng7815@163.com; ZHAO Feng, Email: qingliang1971@126.com
Valve-in-valve procedure; transcatheter aortic valve replacement; bioprosthetic valve failure; aortic valve; treatment outcome
10.7507/1007-4848.202511002
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Objective  To summarize the clinical experience and mid-term outcomes of transcatheter aortic valve implantation valve-in-valve (TAVI-ViV) for failed surgical bioprostheses in the aortic position. Methods  Patients who underwent TAVI-ViV procedures at Tianjin University Chest Hospital between January 2019 and January 2025 were consecutively enrolled. Baseline characteristics, procedural details, and postoperative hemodynamic performance were collected and analyzed. Early postoperative and follow-up valve hemodynamics were evaluated, and surgical experiences were summarized. The primary endpoint was all-cause mortality, and the secondary endpoint was severe prosthetic valve stenosis. Results  A total of 45 patients were included, with a mean age of (68.38±7.72) years and an average interval between surgeries of (11.00±3.67) years. The Society of Thoracic Surgeons (STS) score was 6.80% (4.29%, 8.21%). The procedural success rate was 97.78% (44/45), with one case aborted due to coronary obstruction. The mean implantation depth was (6.87±3.45) mm, the annular expansion rate ranged from 10% to 40%, and the stent crown compression rate varied from 0% to 42%. The median follow-up duration was 21 months, with 27 patients completing the 2-year follow-up. At 2 years postoperatively, the overall follow-up rate was 92.59% (25/27), and the echocardiographic follow-up rate was 66.67% (18/27). The all-cause mortality rate was 7.41% (2/27). The mean peak aortic valve velocity was 2.96±0.69 m/s, the mean transvalvular gradient was (21.83±10.98) mm Hg, and 3 patients exhibited velocities ≥4 m/s (indicating severe stenosis). The regression analysis showed that the implant depth deviation [β=0.41, SE=0.18, OR=1.51, 95%CI (1.06, 2.30), P=0.024］, the compression rate of the corona [β=2.48, OR=11.93, 95%CI (1.21, 122.40), P=0.034], and the enlargement rate of the annulus [β=1.96, OR=7.13, 95%CI (1.28, 35.50), P=0.026] were the independent predictors of high flow velocity after surgery. Conclusion  The optimal implantation depth for TAVI-ViV using a self-expanding valve system is 4 to 5 mm. When the annular expansion rate approaches 10%, hemodynamic performance can be significantly improved. The degree of crown compression in the valve stent is strongly correlated with elevated postoperative transvalvular gradients.

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