• Zenon Huczek, Szymon Jędrzejczyk, Dariusz Jagielak, Maciej Dąbrowski, Marek Grygier, Monika Gruz-Kwapisz, Wojciech Fil, Piotr Olszówka, Marek Frank, Krzysztof Wilczek, Andrzej Walczak, Jarosław Trębacz, Artur Telichowski, Marcin Protasiewicz, Jerzy Sacha, Bartosz Rymuza, Kajetan Grodecki, Piotr Scisło, Damian Hudziak, Radosław Gocoł, Michał Zembala, Radosław Wilimski, Janusz Kochman, Adam Witkowski, and Wojciech Wojakowski.
• 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
• Pol. Arch. Med. Wewn. 2022 Feb 28; 132 (2).

IntroductionTranscatheter aortic valve‑in ‑valve implantation (ViV‑TAVI) has emerged as an alternative to redo surgery in patients with failed surgical aortic bioprosthesis.ObjectivesWe evaluated the safety and efficacy of ViV‑TAVI in Polish patients after surgical aortic valve replacement.Patients And MethodsThis was a nationwide multicenter registry of ViV‑TAVI procedures. Data were collected using an online form, and the clinical follow ‑up lasted 1 year.ResultsFrom 2008 to 2020, 130 ViV‑TAVI procedures were performed (1.9% of all transcatheter aortic valve implantation [TAVI] cases). A considerable increase in ViV‑TAVI procedures since 2018 has been observed (n = 59, 45% of ViV‑TAVI cases). Hancock II, Freestyle, and homograft were the most frequently treated bioprostheses. The self ‑expanding supra ‑annular Corevalve / Evolut valve was used in 76% of cases. In 21% of cases, the mean postprocedural pressure gradient (PG) exceeded 20 mm Hg. All‑cause mortal‑ity at 1 year was 10.8%. Aortic valve stenosis was associated with a higher mean PG than aortic valve regurgitation or mixed disease (P = 0.004). Supra ‑annular transcatheter aortic valves were associated with lower mean PGs than intra ‑annular valves (P = 0.004). Second ‑generation devices were associated with shorter procedure time (120 min vs 135 min, P = 0.04), less frequent need for additional TAVI (2% vs 10%, P = 0.04), and lower 1‑year cardiovascular mortality (95% vs 82.8%, P = 0.03) than first‑generation valves.ConclusionsTranscatheter treatment of failed bioprostheses is increasingly common, with the best hemodynamic effect shown for supra ‑annular valves. The introduction of second‑generation valves has improved procedural and clinical outcomes.

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