Outcomes of Redo Transcatheter Aortic Valve Replacement According to the Initial and Subsequent Valve Type.
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BORIS DOI
Date of Publication
August 8, 2022
Publication Type
Article
Division/Institute
Author
Landes, Uri | |
Richter, Ilan | |
Danenberg, Haim | |
Kornowski, Ran | |
Sathananthan, Janarthanan | |
De Backer, Ole | |
Søndergaard, Lars | |
Abdel-Wahab, Mohamed | |
Yoon, Sung-Han | |
Makkar, Raj R | |
Thiele, Holger | |
Kim, Won-Keun | |
Hamm, Christian | |
Buzzatti, Nicola | |
Montorfano, Matteo | |
Ludwig, Sebastian | |
Schofer, Niklas | |
Voigtlaender, Lisa | |
Guerrero, Mayra | |
El Sabbagh, Abdallah | |
Rodés-Cabau, Josep | |
Mesnier, Jules | |
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 | |
Barbanti, Marco | |
Tamburino, Corrado | |
Sinning, Jan-Malte | |
Al-Kassou, Baravan | |
Perlman, Gidon Y | |
Ielasi, Alfonso | |
Fraccaro, Chiara | |
Tarantini, Giuseppe | |
De Marco, Federico | |
Witberg, Guy | |
Redwood, Simon R | |
Lisko, John C | |
Babaliaros, Vasilis C | |
Laine, Mika | |
Nerla, Roberto | |
Finkelstein, Ariel | |
Eitan, Amnon | |
Jaffe, Ronen | |
Ruile, Philipp | |
Neumann, Franz J | |
Piazza, Nicolo | |
Sievert, Horst | |
Sievert, Kolja | |
Russo, Marco | |
Andreas, Martin | |
Bunc, Matjaz | |
Latib, Azeem | |
Bruoha, Sharon | |
Godfrey, Rebecca | |
Hildick-Smith, David | |
Barbash, Israel | |
Segev, Amit | |
Maurovich-Horvat, Pál | |
Szilveszter, Balint | |
Spargias, Konstantinos | |
Aravadinos, Dionisis | |
Nazif, Tamim M | |
Leon, Martin B | |
Webb, John G |
Subject(s)
Series
JACC. Cardiovascular Interventions
ISSN or ISBN (if monograph)
1876-7605
Publisher
Elsevier
Language
English
Publisher DOI
PubMed ID
35926921
Uncontrolled Keywords
Description
BACKGROUND
As transcatheter aortic valve (TAV) replacement is increasingly used in patients with longer life expectancy, a sizable proportion will require redo TAV replacement (TAVR). The unique configuration of balloon-expandable TAV (bTAV) vs a self-expanding TAV (sTAV) potentially affects TAV-in-TAV outcome.
OBJECTIVES
The purpose of this study was to better inform prosthesis selection, TAV-in-TAV outcomes were assessed according to the type of initial and subsequent TAV.
METHODS
Patients from the Redo-TAVR registry were analyzed using propensity weighting according to their initial valve type (bTAV [n = 115] vs sTAV [n = 106]) and subsequent valve type (bTAV [n = 130] vs sTAV [n = 91]).
RESULTS
Patients with failed bTAVs presented later (vs sTAV) (4.9 ± 2.1 years vs 3.7 ± 2.3 years; P < 0.001), with smaller effective orifice area (1.0 ± 0.7 cm2 vs 1.3 ± 0.8 cm2; P = 0.018) and less frequent dominant regurgitation (16.2% vs 47.3%; P < 0.001). Mortality at 30 days was 2.3% (TAV-in-bTAV) vs 0% (TAV-in-sTAV) (P = 0.499) and 1.7% (bTAV-in-TAV) vs 1.0% (sTAV-in-TAV) (P = 0.612); procedural safety was 72.6% (TAV-in-bTAV) vs 71.2% (TAV-in-sTAV) (P = 0.817) and 73.2% (bTAV-in-TAV) vs 76.5% (sTAV-in-TAV) (P = 0.590). Device success was similar according to initial valve type but higher with subsequent sTAV vs bTAV (77.2% vs 64.3%; P = 0.045), primarily because of lower residual gradients (10.3 mm Hg [8.9-11.7 mm Hg] vs 15.2 mm Hg [13.2-17.1 mm Hg]; P < 0.001). Residual regurgitation (moderate or greater) was similar after bTAV-in-TAV and sTAV-in-TAV (5.7%) and nominally higher after TAV-in-bTAV (9.1%) vs TAV-in-sTAV (4.4%) (P = 0.176).
CONCLUSIONS
In selected patients, no association was observed between TAV type and redo TAVR safety or mortality, yet subsequent sTAV was associated with higher device success because of lower redo gradients. These findings are preliminary, and more data are needed to guide valve choice for redo TAVR.
As transcatheter aortic valve (TAV) replacement is increasingly used in patients with longer life expectancy, a sizable proportion will require redo TAV replacement (TAVR). The unique configuration of balloon-expandable TAV (bTAV) vs a self-expanding TAV (sTAV) potentially affects TAV-in-TAV outcome.
OBJECTIVES
The purpose of this study was to better inform prosthesis selection, TAV-in-TAV outcomes were assessed according to the type of initial and subsequent TAV.
METHODS
Patients from the Redo-TAVR registry were analyzed using propensity weighting according to their initial valve type (bTAV [n = 115] vs sTAV [n = 106]) and subsequent valve type (bTAV [n = 130] vs sTAV [n = 91]).
RESULTS
Patients with failed bTAVs presented later (vs sTAV) (4.9 ± 2.1 years vs 3.7 ± 2.3 years; P < 0.001), with smaller effective orifice area (1.0 ± 0.7 cm2 vs 1.3 ± 0.8 cm2; P = 0.018) and less frequent dominant regurgitation (16.2% vs 47.3%; P < 0.001). Mortality at 30 days was 2.3% (TAV-in-bTAV) vs 0% (TAV-in-sTAV) (P = 0.499) and 1.7% (bTAV-in-TAV) vs 1.0% (sTAV-in-TAV) (P = 0.612); procedural safety was 72.6% (TAV-in-bTAV) vs 71.2% (TAV-in-sTAV) (P = 0.817) and 73.2% (bTAV-in-TAV) vs 76.5% (sTAV-in-TAV) (P = 0.590). Device success was similar according to initial valve type but higher with subsequent sTAV vs bTAV (77.2% vs 64.3%; P = 0.045), primarily because of lower residual gradients (10.3 mm Hg [8.9-11.7 mm Hg] vs 15.2 mm Hg [13.2-17.1 mm Hg]; P < 0.001). Residual regurgitation (moderate or greater) was similar after bTAV-in-TAV and sTAV-in-TAV (5.7%) and nominally higher after TAV-in-bTAV (9.1%) vs TAV-in-sTAV (4.4%) (P = 0.176).
CONCLUSIONS
In selected patients, no association was observed between TAV type and redo TAVR safety or mortality, yet subsequent sTAV was associated with higher device success because of lower redo gradients. These findings are preliminary, and more data are needed to guide valve choice for redo TAVR.
File(s)
| File | File Type | Format | Size | License | Publisher/Copright statement | Content | |
|---|---|---|---|---|---|---|---|
| Outcomes of Redo Transcatheter Aortic Valve Replacement According to the Initial and Subsequent Valve Type.pdf | text | Adobe PDF | 1.73 MB | publisher | published |