Transcatheter aortic valve-in-valve implantation to treat aortic para-valvular regurgitation after TAVI

Uri Landes, Olga Morelli, Haim Danenberg, Janarthanan Sathananthan, Ole De Backer, Lars Sondergaard, Mohamed Abdel-Wahab, Sung Han Yoon, Raj R. Makkar, Holger Thiele, Won Keun Kim, Christian Hamm, Mayra Guerrero, Josep Rodés-Cabau, Taishi Okuno, Thomas Pilgrim, Antonio Mangieri, Nicolas M. Van Mieghem, Didier Tchétché, Wolfgang H. SchoelsMarco Barbanti, Jan Malte Sinning, Alfonso Ielasi, Giuseppe Tarantini, Federico De Marco, Ariel Finkelstein, Horst Sievert, Martin Andreas, Azeem Latib, Rebecca Godfrey, David Hildick-Smith, Lisa Manevich, Ran Kornowski, Tamim M. Nazif, Martin B. Leon, John G. Webb

Research output: Contribution to journalArticlepeer-review

Abstract

Background: 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). Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
JournalInternational Journal of Cardiology
DOIs
StateAccepted/In press - 2022

Keywords

  • Para-valvular aortic regurgitation
  • Para-valvular leak
  • Redo-TAVI
  • TAVI
  • Valve-in-valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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