Transcatheter aortic valve implantation into failing aortic xenografts is increasingly accepted as a new treatment option for patients in need of re-do open heart surgery. Aim of the study was to compare the acute transvalvular hemodynamics between the Medtronic Corevalve (MCV) prosthesis and the Edwards SAPIEN-valve (ESV) after valve-in-valve implantation (ViVI).

A total of 24 pts (70.8% male, aged 72.6±6.7 years, mean logES 32.2±19.4%) underwent a transfemoral transcatheter ViVI for a failing aortic xenograft at our institution. Due to the high frequency of small surgical valves (outer diameter - OD - 21mm: n=11; 23mm n=8; 25mm n=2; ≥27mm n=3) ViVI was predominantly done with the MCV (17pts; 71%) compared to ESV (7pts; 29%: Edwards Sapien n=2, Sapien XT n=5).

Procedural success rate was 87.5%, with 1 pt. displaying moderate aortic regurgitation (deep implanted MCV) and 2 pts. in need of a second MCV due to valve embolisation into the ascending aorta (after attempting a high implantation within small surgical xenografts, both with an OD of 21mm). Thirty-day-mortality was 0%. The average mean aortic valve gradient (dPmean) decreased significantly after ViVI (30.6±14 vs. 14.3±6.1 mmHg). Acute hemodynamic data was significantly superior with MCV implanted into xenografts with an OD≤ 23mm (MCV n=13: dPmean 12.0±3.9 mmHg; ESV n=3: dPmean 25.6±2.51 mmHg, p=0.02) and severe patient prosthesis mismatch was more likely with ESV (indexed effective orifice area: 0.64±0.19 vs. 0.86±0.16, p=0.04). The significantly higher gradient with ESV vs. MCV after ViVI into xenografts with an OD of ≤23mm was confirmed by comparison of pooled and recently published data of n=64 ESV (Pmean 17.8±8.4 mmHg; p=0.009).

The low 30d mortality suggests that percutaneous transcatheter ViV-procedures for failing bioprosthetical aortic valves is an effective treatment option for high-risk surgical patients. The MCV should be considered as the first choice in small surgical xenografts (OD ≤ 23mm) due to lower remaining transvalvular gradients. Nevertheless, the more demanding implantation with MCV indicates that a smaller MCV-prosthesis (i.e. 23mm) is urgently needed to increase the safety of ViVI.