Turk Kardiyol Dern Ars. Ahead of Print: TKDA-70672 | DOI: 10.5543/tkda.2026.70672
The Association Between Procedure-Related Complications and Mortality After Valve-in-Valve TAVI: A Single-Center Study
Songul Usalp1, Metehan Kibar1, Ayşenur Küçük1, Şeymanur Çiçek1, Mustafa Furkan Kılıçarslan1, Furkan Baturalp Erdoğan1, Çağdaş Bulus1, İsmail Balaban1, Hakan Çakır1, Regayip Zehir1, Mehmet Kaan Kıralı21Department of Cardiology, University of Health Sciences Kartal Kosuyolu High Specialisation Training and Research Hospital, İstanbul, Türkiye
2Department of Cardiovascular Surgery University of Health Sciences Kartal Kosuyolu High Specialisation Training and Research Hospital, İstanbul, Türkiye
Objective: Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is an effective treatment option for failed bioprosthetic valves. However, data on mortality predictors, particularly the relative impact of procedural versus baseline clinical factors, remain limited. This study aimed to evaluate all-cause mortality and identify predictors of adverse outcomes in patients undergoing ViV-TAVI.
Method: This retrospective, single-center study included 32 consecutive patients who underwent ViV-TAVI between 2020 and 2025. Patients were stratified into survivor and non-survivor groups. Clinical, procedural, laboratory, and echocardiographic variables were analyzed. Overall survival was evaluated using Kaplan-Meier analysis, while predictors of mortality were examined using Cox proportional hazards regression.
Results: The mean age was 76.0±8.0 years, and 50% of the patients were female. During a median follow-up of 534 days, all-cause mortality occurred in 25% of patients. Non-survivors were older (78.5 vs. 75.1 years, P = 0.398) and more frequently female (75% vs. 41.7%, P = 0.220). Major vascular injury with retroperitoneal hemorrhage was significantly more common among non-survivors (P = 0.016) and was strongly associated with mortality in both univariate (HR 7.43, 95% CI 1.43–39.71, P = 0.018) and multivariate analyses (HR 9.5, 95% CI 1.840–49.210, P = 0.008). Baseline echocardiographic and laboratory parameters were not associated with mortality.
Conclusion: In this small exploratory cohort study, major vascular injury accompanied by retroperitoneal hemorrhage was associated with increased midterm mortality. These findings are preliminary and hypothesis-generating and require validation in larger, multicenter studies. The results underscore the potential importance of procedural optimization and the prevention of vascular complications in improving clinical outcomes.
Keywords: Mortality, valve-in-valve transcatheter aortic valve implantation, vascular complications.
Corresponding Author: Songul Usalp
Manuscript Language: English