1. Transcatheter aortic valve-in-valve implantation to treat aortic para-valvular regurgitation after TAVI.
- Author
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Landes, Uri, Morelli, Olga, Danenberg, Haim, Sathananthan, Janarthanan, Backer, Ole De, Sondergaard, Lars, Abdel-Wahab, Mohamed, Yoon, Sung-Han, Makkar, Raj R., Thiele, Holger, Kim, Won-Keun, Hamm, Christian, Guerrero, Mayra, Rodés-Cabau, Josep, Okuno, Taishi, Pilgrim, Thomas, Mangieri, Antonio, Van Mieghem, Nicolas M., Tchétché, Didier, and Schoels, Wolfgang H.
- Subjects
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AORTIC valve insufficiency , *HEART valve prosthesis implantation , *PATIENT selection , *AORTA , *AORTIC valve , *ECHOCARDIOGRAPHY - Abstract
Para-valvular regurgitation (PVR) after transcatheter aortic valve (TAV) implantation is associated with increased mortality. Redo-TAVI may be applied to treat PVR, yet with unknown efficacy. We thought to assess redo-TAVI efficacy in reducing PVR using the Redo-TAVI registry (45 centers; 600 TAV-in-TAV cases). Patients were excluded if redo-TAVI was done urgently (N = 253), for isolated TAV stenosis (N = 107) or if regurgitation location at presentation remained undetermined (N = 123). The study group of patients with PVR (N = 70) were compared against patients with intra-valvular regurgitation (IVR) (N = 41). Echocardiographic examinations of 67 (60%) patients were reassessed in a core-lab for data accuracy validation. Core-lab examination validated the jet location in 66 (98.5%) patients. At 30 days, the rate of residual AR ≥ moderate was 7 (10%) in the PVR cohort vs. 1 (2.4%) in the IVR cohort, p = 0.137. The rate of procedural success was 53 (75.7%) vs. 33 (80.5%), p = 0.561; procedural safety 51 (72.8%) vs. 31 (75.6%), p = 0.727; and mortality 2 (2.9%) vs. 1 (2.4%), p = 0.896 at 30 days and 7 (18.6%) vs. 2 (11.5%), p = 0.671 at 1 year, respectively. Of patients with residual PVR ≥ moderate at 30 days, 5/7 occurred after implanting balloon-expandable in self-expanding TAV and 2/7 after balloon-expandable in balloon-expandable TAV. This study puts in perspective redo-TAVI efficacy and limitations to treat PVR after TAVI. Patient selection for this and other therapies for PVR needs further investigation. • Para-valvular regurgitation (PVR) after TAVI is associated with increased mortality. • Redo-TAVI reduced PVR in 90% of patients with PVR after TAVI. • AR persisted in 10% of patients with PVR vs. 2.4% with intra-valvular AR, p = 0.137. • Procedural success, safety and mortality were comparable. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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