Background The transcatheter valve-in-valve treatment (TAV-in-TAV) of degenerated transcatheter aortic valves is becoming more relevant, as the use of transcatheter aortic valve replacement (TAVR) increases. We report our experience with TAV-in-TAV in patients with a degenerated transcatheter heart valve (THV).

Methods We retrospectively analyzed prospectively collected data from our designated TAVR database. Intraprocedural and intrahospital outcomes were reported.

Results Ten patients out of a total of 3,144 TAVR implantations since 2007 presented with a degenerated THV, among those six with an Edwards Sapien XT (Edwards Lifesciences, Irvine, California, United States) valve, treated with a Medtronic Evolut R (Medtronic, Dublin, Ireland) valve. Four patients had severe stenosis, one pure insufficiency, and five combined stenosis and insufficiency. Average time between initial implantation and re-intervention was 6.8 ± 1.3 years. The mean preoperative maximum and mean gradients were 54.2 ± 14.8 mm Hg and 31.6 ± 9.9 mm Hg, respectively. Nine patients underwent transfemoral and one patient underwent transaortic TAV-in-TAV. Mean procedural time was 86.2 ± 51.5 minutes. Post-implantation, the maximum and mean gradients decreased to 18 ± 6.9 mm Hg and 8.4 ± 3.2 mm Hg (16 ± 8 mm Hg and 6.4 ± 1.7 mm Hg in the Evolut-in-Sapien subgroup), respectively. The valve area increased from 0.98 ± 0.28 mm Hg to 1.72 ± 0.32 mm Hg (0.8 ± 0.07 mm Hg to 1.9 ± 0.16 mm Hg in the Evolut-in-Sapien subgroup). Two patients experienced a vascular complication. No further Valve Academic Research Consortium-2 criteria complications occurred during hospitalization.

Conclusion TAV-in-TAV resulted in low procedural and peri-procedural complication rates. In particular, the usage of a supra-annular valve resulted in excellent hemodynamic results. Larger studies are required to validate this observational data and to establish a protocol for this procedure.

背景 随着经导管主动脉瓣置换术 (TAVR) 的使用增加，退化的经导管主动脉瓣的经导管瓣中瓣治疗 (TAV-in-TAV) 变得越来越重要。我们报告了我们在退行导管心脏瓣膜 (THV) 患者中使用 TAV-in-TAV 的经验。

方法 我们回顾性分析了从我们指定的 TAVR 数据库中前瞻性收集的数据。报告了术中和院内结局。

结果 自 2007 年以来，总共 3,144 例 TAVR 植入患者中有 10 例出现 THV 退化，其中 6 例使用 Edwards Sapien XT（Edwards Lifesciences，Irvine，California，United States）瓣膜，使用 Medtronic Evolut R（Medtronic，都柏林，爱尔兰）阀门。重度狭窄4例，单纯供血不足1名，合并狭窄和供血不足5名。初次植入和再次干预之间的平均时间为 6.8 ± 1.3 年。术前平均最大和平均梯度分别为 54.2 ± 14.8 mm Hg 和 31.6 ± 9.9 mm Hg。9 名患者接受了经股动脉，1 名患者接受了经主动脉 TAV-in-TAV。平均手术时间为 86.2 ± 51.5 分钟。植入后，最大和平均梯度下降到 18 ± 6.9 mm Hg 和 8.4 ± 3.2 mm Hg（16 ± 8 mm Hg 和 6.4 ± 1. 7 mm Hg 在 Evolut-in-Sapien 亚组中），分别。瓣膜面积从 0.98 ± 0.28 mm Hg 增加到 1.72 ± 0.32 mm Hg（在 Evolut-in-Sapien 亚组中从 0.8 ± 0.07 mm Hg 增加到 1.9 ± 0.16 mm Hg）。两名患者出现血管并发症。住院期间未发生进一步的 Valve Academic Research Consortium-2 标准并发症。

结论 TAV-in-TAV 导致较低的手术和围手术期并发症发生率。特别是，使用超环瓣导致了极好的血流动力学结果。需要更大规模的研究来验证这些观察数据并为此程序建立协议。