Outcomes of Redo Transcatheter Aortic Valve Replacement According to the Initial and Subsequent Valve Type

• DOI: 10.1016/j.jcin.2022.05.016
• Publication Date: 2022-07-13T21:04:16Z
• Authors: Uri Landes; Ilan Richter; Haim Danenberg; Ran Kornowski; Janarthanan Satha...; Ole De Backer; Lars Søndergaard; Mohamed Abdel-Wahab; Sung-Han Yoon; Raj R. Makkar; Holger Thiele; Won-Keun Kim; Christian Hamm; Nicola Buzzatti; Matteo Montorfano; Sebastian Ludwig; Niklas Schofer; Lisa Voigtlaender; Mayra Guerrero; Abdallah El Sabbagh; Josep Rodés-Cabau; Jules Mesnier; Taishi Okuno; Thomas Pilgrim; Claudia Fiorina; Antonio Colombo; Antonio Mangieri; Helene Eltchaninoff; Luis Nombela-Franco; Maarten P.H. Van ...; Nicolas M. Van Mi...; Didier Tchétché; Wolfgang H. Schoels; Matthias Kullmer; Marco Barbanti; Corrado Tamburino; Jan-Malte Sinning; Baravan Al-Kassou; Gidon Y. Perlman; Alfonso Ielasi; Chiara Fraccaro; Giuseppe Tarantini; Federico De Marco; Guy Witberg; Simon R. Redwood; John C. Lisko; Vasilis C. Babali...; Mika Laine; Roberto Nerla; Ariel Finkelstein; Amnon Eitan; Ronen Jaffe; Philipp Ruile; Franz J. Neumann; Nicolo Piazza; Horst Sievert; Kolja Sievert; Marco Russo; Martin Andreas; Matjaz Bunc; Azeem Latib; Sharon Bruoha; Rebecca Godfrey; David Hildick-Smith; Israel Barbash; Amit Segev; Pál Maurovich-Horvat; Balint Szilveszter; Konstantinos Spar...; Dionisis Aravadinos; Tamim M. Nazif; Martin B. Leon; John G. Webb
• Keywords: self-expanding valve; valve-in-valve; redo TAVR; 610; TAVR; balloon-expandable valve; redo TAVR; self-expanding valve; valve-in-valve; Aortic Valve; Humans; Prosthesis Design; Registries; Risk Factors; Treatment Outcome; Aortic Valve Stenosis; Heart Valve Prosthesis; Transcatheter Aortic Valve Replacement; Aortic Valve Stenosis; TAVR; Prosthesis Design; 3. Good health; Transcatheter Aortic Valve Replacement; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; SDG 3 - Good Health and Well-being; Risk Factors; Aortic Valve; Heart Valve Prosthesis; Humans; balloon-expandable valve; Registries

As transcatheter aortic valve (TAV) replacement is increasingly used in patients with longer life expectancy, a sizable proportion will require redo TAV replacement (TAVR). The unique configuration of balloon-expandable TAV (bTAV) vs a self-expanding TAV (sTAV) potentially affects TAV-in-TAV outcome.The purpose of this study was to better inform prosthesis selection, TAV-in-TAV outcomes were assessed according to the type of initial and subsequent TAV.Patients from the Redo-TAVR registry were analyzed using propensity weighting according to their initial valve type (bTAV [n = 115] vs sTAV [n = 106]) and subsequent valve type (bTAV [n = 130] vs sTAV [n = 91]).Patients with failed bTAVs presented later (vs sTAV) (4.9 ± 2.1 years vs 3.7 ± 2.3 years; P < 0.001), with smaller effective orifice area (1.0 ± 0.7 cm2 vs 1.3 ± 0.8 cm2; P = 0.018) and less frequent dominant regurgitation (16.2% vs 47.3%; P < 0.001). Mortality at 30 days was 2.3% (TAV-in-bTAV) vs 0% (TAV-in-sTAV) (P = 0.499) and 1.7% (bTAV-in-TAV) vs 1.0% (sTAV-in-TAV) (P = 0.612); procedural safety was 72.6% (TAV-in-bTAV) vs 71.2% (TAV-in-sTAV) (P = 0.817) and 73.2% (bTAV-in-TAV) vs 76.5% (sTAV-in-TAV) (P = 0.590). Device success was similar according to initial valve type but higher with subsequent sTAV vs bTAV (77.2% vs 64.3%; P = 0.045), primarily because of lower residual gradients (10.3 mm Hg [8.9-11.7 mm Hg] vs 15.2 mm Hg [13.2-17.1 mm Hg]; P < 0.001). Residual regurgitation (moderate or greater) was similar after bTAV-in-TAV and sTAV-in-TAV (5.7%) and nominally higher after TAV-in-bTAV (9.1%) vs TAV-in-sTAV (4.4%) (P = 0.176).In selected patients, no association was observed between TAV type and redo TAVR safety or mortality, yet subsequent sTAV was associated with higher device success because of lower redo gradients. These findings are preliminary, and more data are needed to guide valve choice for redo TAVR.