Changes in patient characteristics and procedural measures over a 10-year period in aortic valve-in-valve procedures for degenerated surgical bioprostheses

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Objectives Aortic valve-in-valve procedures for treatment of degenerated surgical bioprostheses are an established therapy. In this study, we evaluated how the risk profiles, procedural approaches, and early outcomes for patients in these procedures changed over a period of 10 years. Methods Baseline, procedural, early outcome, and echocardiographic parameters were retrospectively compared between three time periods (period 1: 2013–2016, period 2: 2017–2020, and period 3: 2021–2023). Results Between 2013 and 2023, a total of 256 patients underwent valve-in-valve implantation in degenerated aortic bioprostheses at our center with a steady increase of patient numbers. The median age of the patients was 78.0 (interquartile range 72.2–82.4) years and remained unchanged over time. EuroSCORE II presented lower risk profiles in later periods ( p = 0.001). Access proportions changed with transfemoral access in 100% of patients in period 3 ( p < 0.001). Rates of BASILICA procedures (0% vs. 17.5% vs. 19.4%; p < 0.001) and valve fracturing steadily increased (0% vs. 6.3% vs. 7.8%; p = 0.058). Cerebral protection device use presented a distinct decline to 18.4% in period 3 ( p < 0.001). Procedure time and length of intensive care unit stay decreased significantly over time. Early outcome parameters such as rates of permanent pacemaker implantation, bleeding, acute kidney injury, disabling stroke (0.0% vs. 1.3% vs. 1.0%; p = 0.653), and device success (91.8% vs. 92.5% vs. 98.1%; p = 0.123) showed no significant changes over time. The rate of 30-day mortality decreased to 0% in period 3 ( p = 0.069). Conclusion Advancements in technical approaches have expanded eligibility for patients previously considered unsuitable for aortic valve-in-valve procedures. In this study, it was found that early outcomes for patients were excellent, with improvement over time, highlighting the clinical efficacy and safety of the procedures.

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