Repeat Transcatheter Aortic Valve Replacement for Transcatheter Prosthesis Dysfunction

Uri Landes, John G. Webb, Ole De Backer, Lars Sondergaard, Mohamed Abdel-Wahab, Lisa Crusius, Won Keun Kim, Christian Hamm, Nicola Buzzatti, Matteo Montorfano, Sebastian Ludwig, Niklas Schofer, Lisa Voigtlaender, Mayra Guerrero, Abdallah El Sabbagh, Josep Rodés-Cabau, Leonardo Guimaraes, Ran Kornowski, Pablo Codner, Taishi OkunoThomas Pilgrim, Claudia Fiorina, Antonio Colombo, Antonio Mangieri, Helene Eltchaninoff, Luis Nombela-Franco, Maarten P.H. Van Wiechen, Nicolas M. Van Mieghem, Didier Tchétché, Wolfgang H. Schoels, Matthias Kullmer, Corrado Tamburino, Jan Malte Sinning, Baravan Al-Kassou, Gidon Y. Perlman, Haim Danenberg, Alfonso Ielasi, Chiara Fraccaro, Giuseppe Tarantini, Federico De Marco, Guy Witberg, Simon R. Redwood, John C. Lisko, Vasilis C. Babaliaros, Mika Laine, Roberto Nerla, Fausto Castriota, Ariel Finkelstein, Itamar Loewenstein, Amnon Eitan, Ronen Jaffe, Philipp Ruile, Franz J. Neumann, Nicolo Piazza, Hind Alosaimi, Horst Sievert, Kolja Sievert, Marco Russo, Martin Andreas, Matjaz Bunc, Azeem Latib, Rebecca Govdfrey, David Hildick-Smith, Janarthanan Sathananthan, Mark Hensey, Abdullah Alkhodair, Philipp Blanke, Jonathon Leipsic, David A. Wood, Tamim M. Nazif, Susheel Kodali, Martin B. Leon, Marco Barbanti

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)1882-1893
Number of pages12
JournalJournal of the American College of Cardiology
Volume75
Issue number16
DOIs
StatePublished - Apr 28 2020

Keywords

  • durability
  • transcatheter aortic valve replacement
  • transcatheter heart valve
  • valve-in-valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Landes, U., Webb, J. G., De Backer, O., Sondergaard, L., Abdel-Wahab, M., Crusius, L., Kim, W. K., Hamm, C., Buzzatti, N., Montorfano, M., Ludwig, S., Schofer, N., Voigtlaender, L., Guerrero, M., El Sabbagh, A., Rodés-Cabau, J., Guimaraes, L., Kornowski, R., Codner, P., ... Barbanti, M. (2020). Repeat Transcatheter Aortic Valve Replacement for Transcatheter Prosthesis Dysfunction. Journal of the American College of Cardiology, 75(16), 1882-1893. https://doi.org/10.1016/j.jacc.2020.02.051