Repeat Transcatheter Aortic Valve Replacement for Transcatheter Prosthesis Dysfunction |
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| Affiliation: | 1. Centre for Cardiovascular Innovation Centre for Heart Valve Innovation, St. Paul’s and Vancouver General Hospital, Vancouver, British Columbia, Canada;2. Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel;3. Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark;4. Herzzentrum Leipzig, Leipzig, Germany;5. Kerckhoff Heart Center, Bad Nauheim, Germany;6. San Raffaele Scientific Institute, Milan, Italy;7. University Heart Center Hamburg, Hamburg, Germany;8. Mayo Clinic, Rochester, Minnesota;9. Quebec Heart and Lung Institute, Quebec, Quebec, Canada;10. University Hospital of Bern, Bern, Switzerland;11. Spedali Civili Brescia, Brescia, Italy;12. Maria Cecilia Hospital, Cotignola, Ravenna, Italy;13. Normandie Univ, UNIROUEN, INSERM U1096, Rouen University Hospital, Department of Cardiology, FHU REMOD-VHF, F76000, Rouen, France;14. Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain;15. Erasmus University Medical Center, Rotterdam, the Netherlands;p. Clinique Pasteur, Toulouse, France;q. Herzzentrum Duisburg, Duisburg, Germany;r. A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy;s. University Hospital Bonn, Bonn, Germany;t. Hadassah Medical Center, Jerusalem, Israel;u. S. Ambrogio Cardio-Thoracic Center, Milan, Italy;v. University Hospital of Padova, Padova, Italy;w. IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy;x. St. Thomas’ Hospital Campus, London, United Kingdom;y. Emory University Hospital, Atlanta, Georgia;z. Helsinki University Central Hospital, Helsinki, Finland;11. Humanitas Gavazzeni, Bergamo, Italy;22. Tel-Aviv Medical Center, Tel-Aviv, Israel;33. Carmel Medical Center, Haifa, Israel;44. University Heart Center Freiburg, Bad Krozingen, Germany;55. McGill University Health Center, Montreal, Quebec, Canada;66. Cardiovascular Center, Frankfurt, Germany;77. Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria;88. University Medical Centre Ljubljana, Ljubljana, Slovenia;99. Montefiore Medical Center, New York, New York;1010. Brighton & Sussex University Hospitals NHS Trust, Brighton, United Kingdom;1111. Columbia University Medical Center, New York, New York |
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| Abstract: | BackgroundTranscatheter 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.ObjectivesThe authors sought to examine outcomes following redo-TAVR.MethodsThe 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.ResultsAmong 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.ConclusionsRedo-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. |
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| Keywords: | durability transcatheter aortic valve replacement transcatheter heart valve valve-in-valve AR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0035" }," $$" :[{" #name" :" text" ," _" :" aortic regurgitation AS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" aortic stenosis CT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" computed tomography TAVR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" transcatheter aortic valve replacement THV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0075" }," $$" :[{" #name" :" text" ," _" :" transcatheter heart valve VARC-2" },{" #name" :" keyword" ," $" :{" id" :" kwrd0085" }," $$" :[{" #name" :" text" ," _" :" Valve Academic Research Consortium-2 |
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