Repeat Transcatheter Aortic Valve Replacement for Transcatheter Prosthesis Dysfunction.
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BORIS DOI
Publisher DOI
PubMed ID
32327098
Description
BACKGROUND
Transcatheter aortic valve replacement (TAVR) use is increasing in patients with longer life expectancy, yet robust data on the durability of transcatheter heart valves (THVs) are limited. Redo-TAVR may play a key strategy in treating patients in whom THVs fail.
OBJECTIVES
The authors sought to examine outcomes following redo-TAVR.
METHODS
The Redo-TAVR registry collected data on consecutive patients who underwent redo-TAVR at 37 centers. Patients were classified as probable TAVR failure or probable THV failure if they presented within or beyond 1 year of their index TAVR, respectively.
RESULTS
Among 63,876 TAVR procedures, 212 consecutive redo-TAVR procedures were identified (0.33%): 74 within and 138 beyond 1 year of the initial procedure. For these 2 groups, TAVR-to-redo-TAVR time was 68 (38 to 154) days and 5 (3 to 6) years. The indication for redo-TAVR was THV stenosis in 12 (16.2%) and 51 (37.0%) (p = 0.002) and regurgitation or combined stenosis-regurgitation in 62 (83.8%) and 86 (62.3%) (p = 0.028), respectively. Device success using VARC-2 criteria was achieved in 180 patients (85.1%); most failures were attributable to high residual gradients (14.1%) or regurgitation (8.9%). At 30-day and 1-year follow-up, residual gradients were 12.6 ± 7.5 mm Hg and 12.9 ± 9.0 mm Hg; valve area 1.63 ± 0.61 cm2 and 1.51 ± 0.57 cm2; and regurgitation ≤mild in 91% and 91%, respectively. Peri-procedural complication rates were low (3 stroke [1.4%], 7 valve malposition [3.3%], 2 coronary obstruction [0.9%], 20 new permanent pacemaker [9.6%], no mortality), and symptomatic improvement was substantial. Survival at 30 days was 94.6% and 98.5% (p = 0.101) and 83.6% and 88.3% (p = 0.335) at 1 year for patients presenting with early and late valve dysfunction, respectively.
CONCLUSIONS
Redo-TAVR is a relatively safe and effective option for selected patients with valve dysfunction after TAVR. These results are important for applicability of TAVR in patients with long life expectancy in whom THV durability may be a concern.
Transcatheter aortic valve replacement (TAVR) use is increasing in patients with longer life expectancy, yet robust data on the durability of transcatheter heart valves (THVs) are limited. Redo-TAVR may play a key strategy in treating patients in whom THVs fail.
OBJECTIVES
The authors sought to examine outcomes following redo-TAVR.
METHODS
The Redo-TAVR registry collected data on consecutive patients who underwent redo-TAVR at 37 centers. Patients were classified as probable TAVR failure or probable THV failure if they presented within or beyond 1 year of their index TAVR, respectively.
RESULTS
Among 63,876 TAVR procedures, 212 consecutive redo-TAVR procedures were identified (0.33%): 74 within and 138 beyond 1 year of the initial procedure. For these 2 groups, TAVR-to-redo-TAVR time was 68 (38 to 154) days and 5 (3 to 6) years. The indication for redo-TAVR was THV stenosis in 12 (16.2%) and 51 (37.0%) (p = 0.002) and regurgitation or combined stenosis-regurgitation in 62 (83.8%) and 86 (62.3%) (p = 0.028), respectively. Device success using VARC-2 criteria was achieved in 180 patients (85.1%); most failures were attributable to high residual gradients (14.1%) or regurgitation (8.9%). At 30-day and 1-year follow-up, residual gradients were 12.6 ± 7.5 mm Hg and 12.9 ± 9.0 mm Hg; valve area 1.63 ± 0.61 cm2 and 1.51 ± 0.57 cm2; and regurgitation ≤mild in 91% and 91%, respectively. Peri-procedural complication rates were low (3 stroke [1.4%], 7 valve malposition [3.3%], 2 coronary obstruction [0.9%], 20 new permanent pacemaker [9.6%], no mortality), and symptomatic improvement was substantial. Survival at 30 days was 94.6% and 98.5% (p = 0.101) and 83.6% and 88.3% (p = 0.335) at 1 year for patients presenting with early and late valve dysfunction, respectively.
CONCLUSIONS
Redo-TAVR is a relatively safe and effective option for selected patients with valve dysfunction after TAVR. These results are important for applicability of TAVR in patients with long life expectancy in whom THV durability may be a concern.
Date of Publication
2020-04-28
Publication Type
Article
Subject(s)
Keyword(s)
durability transcatheter aortic valve replacement transcatheter heart valve valve-in-valve
Language(s)
en
Contributor(s)
Landes, Uri | |
Webb, John G | |
De Backer, Ole | |
Sondergaard, Lars | |
Abdel-Wahab, Mohamed | |
Crusius, Lisa | |
Kim, Won-Keun | |
Hamm, Christian | |
Buzzatti, Nicola | |
Montorfano, Matteo | |
Ludwig, Sebastian | |
Schofer, Niklas | |
Voigtlaender, Lisa | |
Guerrero, Mayra | |
El Sabbagh, Abdallah | |
Rodés-Cabau, Josep | |
Guimaraes, Leonardo | |
Kornowski, Ran | |
Codner, Pablo | |
Fiorina, Claudia | |
Colombo, Antonio | |
Mangieri, Antonio | |
Eltchaninoff, Helene | |
Nombela-Franco, Luis | |
Van Wiechen, Maarten P H | |
Van Mieghem, Nicolas M | |
Tchétché, Didier | |
Schoels, Wolfgang H | |
Kullmer, Matthias | |
Tamburino, Corrado | |
Sinning, Jan-Malte | |
Al-Kassou, Baravan | |
Perlman, Gidon Y | |
Danenberg, Haim | |
Ielasi, Alfonso | |
Fraccaro, Chiara | |
Tarantini, Giuseppe | |
De Marco, Federico | |
Witberg, Guy | |
Redwood, Simon R | |
Lisko, John C | |
Babaliaros, Vasilis C | |
Laine, Mika | |
Nerla, Roberto | |
Castriota, Fausto | |
Finkelstein, Ariel | |
Loewenstein, Itamar | |
Eitan, Amnon | |
Jaffe, Ronen | |
Ruile, Philipp | |
Neumann, Franz J | |
Piazza, Nicolo | |
Alosaimi, Hind | |
Sievert, Horst | |
Sievert, Kolja | |
Russo, Marco | |
Andreas, Martin | |
Bunc, Matjaz | |
Latib, Azeem | |
Govdfrey, Rebecca | |
Hildick-Smith, David | |
Sathananthan, Janarthanan | |
Hensey, Mark | |
Alkhodair, Abdullah | |
Blanke, Philipp | |
Leipsic, Jonathon | |
Wood, David A | |
Nazif, Tamim M | |
Kodali, Susheel | |
Leon, Martin B | |
Barbanti, Marco |
Additional Credits
Series
Journal of the American College of Cardiology
Publisher
Elsevier
ISSN
0735-1097
Access(Rights)
restricted