1. Repeat Transcatheter Aortic Valve Replacement for Transcatheter Prosthesis Dysfunction
- Author
-
Simon Redwood, Josep Rodés-Cabau, Sebastian Ludwig, Pablo Codner, David A. Wood, Franz J. Neumann, Martin Andreas, Marco Barbanti, Matjaz Bunc, Fausto Castriota, Won-Keun Kim, Leonardo Guimaraes, Baravan Al-Kassou, Abdullah Alkhodair, Jonathon Leipsic, Nicolo Piazza, Ran Kornowski, Horst Sievert, John Lisko, Lisa Crusius, Philipp Ruile, Ronen Jaffe, Kolja Sievert, Uri Landes, Gidon Y. Perlman, Tamim Nazif, Antonio Colombo, Niklas Schofer, Matteo Montorfano, Roberto Nerla, Mika Laine, Mohamed Abdel-Wahab, Azeem Latib, Corrado Tamburino, Susheel Kodali, Didier Tchetche, Mark Hensey, Taishi Okuno, Mayra Guerrero, Maarten P van Wiechen, Antonio Mangieri, Amnon Eitan, Vasilis C. Babaliaros, Martin B. Leon, Nicolas M. Van Mieghem, Thomas Pilgrim, Chiara Fraccaro, Giuseppe Tarantini, Hind Alosaimi, Ole De Backer, Luis Nombela-Franco, Federico De Marco, Lars Søndergaard, Christian W. Hamm, Ariel Finkelstein, Jan Malte Sinning, Haim D. Danenberg, Wolfgang Schoels, John G. Webb, Claudia Fiorina, David Hildick-Smith, Hélène Eltchaninoff, Guy Witberg, Philipp Blanke, Rebecca Govdfrey, Alfonso Ielasi, Janarthanan Sathananthan, Abdallah El Sabbagh, Itamar Loewenstein, Lisa Voigtlaender, Marco Russo, Matthias Kullmer, Nicola Buzzatti, and Cardiology
- Subjects
Male ,Reoperation ,valve-in-valve ,medicine.medical_specialty ,Transcatheter aortic ,transcatheter heart valve ,medicine.medical_treatment ,Aortic Valve Insufficiency ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,Global Health ,Prosthesis ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Valve replacement ,Outcome Assessment, Health Care ,Humans ,Medicine ,durability ,transcatheter aortic valve replacement ,Registries ,030212 general & internal medicine ,610 Medicine & health ,Stroke ,Aged ,business.industry ,Aortic Valve Stenosis ,medicine.disease ,Survival Analysis ,Surgery ,Equipment Failure Analysis ,Stenosis ,Aortic Valve ,Heart Valve Prosthesis ,Female ,Symptom Assessment ,Permanent pacemaker ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
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.
- Published
- 2020