Long-term outcome of bail-out ViV-TAVI at index procedure.

Objective: This study aimed to compare in-hospital and long-term outcomes of patients with bail-out valve-in-valve TAVI due to a primarily failed transcatheter aortic valves procedure (bViV-TAVI) versus a successful transcatheter aortic valve implantation (TAVI).

Methods: We recorded bViV-TAVI procedures at our center from February 2011 to March 2022. Primary endpoint was long-term mortality. In-hospital mortality, stroke, acute kidney failure, need for new permanent pacemaker, and duration of intervention were secondary endpoints.

Results: 4555 patients undergoing TAVI were retrospectively included. 231 matched (77:154) patients were analyzed. BViV-TAVI was a rare event (1.9%). In 76.7% of the cases transcatheter valve embolization and migration were the reasons for implanting a second valve in the same procedure. Significant PVL accounted for bViV-TAVI in 23.4% of the patients. The duration of the intervention was significantly longer for the bViV-TAVI group (p < 0.001). BViV-TAVI patients showed higher rates of a new permanent pacemaker implantation (p = 0.013) and the postprocedural mean pressure was significantly higher (p = 0.03). Concerning the other secondary endpoints there was a trend for a higher event rate in bVIV-TAVI patients which did not reach significant difference. After an average follow-up period of 4.9 ± 3.0 years, mortality was significantly higher in the bViV-TAVI group (54.5% vs. 39.0%, p = 0.025).

Conclusion: The implantation of a second valve during the same procedure as bail-out is a feasible alternative treatment option in patients with failed transcatheter aortic valve procedures. However, increased long-term mortality must be taken into account.