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Outcomes of Repeat TAVR With Balloon-Expandable Valves
Quick Takes
- Redo-TAVR with balloon-expandable transcatheter valves is feasible for treating both aortic stenosis and aortic regurgitation with low rates of procedural complications.
- The clinical outcomes at 30 days and 1 year were affected by the underlying baseline surgical risk, but not by early or late timing of redo-TAVR or the type of the first transcatheter valve implant.
- Redo-TAVR with balloon-expandable transcatheter valves might be a reasonable option for the treatment of failed transcatheter valves in selected patients who are deemed appropriate for redo-TAVR by a multidisciplinary heart team.
Study Questions:
What is the safety and efficacy of redo-transcatheter aortic valve replacement (TAVR) in a national registry?
Methods:
The investigators included all consecutive patients in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry from November 9, 2011, to December 30, 2022, who underwent TAVR with balloon-expandable valves in failed transcatheter heart valves (redo-TAVR) or native aortic valves (native-TAVR). Procedural, echocardiographic, and clinical outcomes were compared between redo-TAVR and native-TAVR cohorts using propensity-score matching. The 30-day and 1-year adverse event rates were based on Kaplan-Meier estimates and all comparisons were made using the log-rank test.
Results:
Among 350,591 patients (1,320 redo-TAVR; 349,271 native-TAVR), 1,320 propensity-matched pairs of patients undergoing redo-TAVR and native-TAVR were analyzed (redo-TAVR cohort: mean age, 78 years [standard deviation 9]; 559 [42.3%] of 1,320 female, 761 [57.7%] male; mean predicted surgical risk of 30-day mortality, 8.1%). The rates of procedural complications of redo-TAVR were low (coronary compression or obstruction: four [0.3%] of 1,320; intraprocedural death: eight [0.6%] of 1,320; conversion to open heart surgery: six [0.5%] of 1,319) and similar to native-TAVR. There was no significant difference between redo-TAVR and native-TAVR populations in death at 30 days (4.7% vs. 4.0%, p = 0.36) or 1 year (17.5% vs. 19.0%, p = 0.57), and stroke at 30 days (2.0% vs. 1.9%, p = 0.84) or 1 year (3.2% vs. 3.5%, p = 0.80). Redo-TAVR reduced aortic valve gradients at 1 year, although they were higher in the redo-TAVR group compared with the native-TAVR group (15 mm Hg vs. 12 mm Hg; p < 0.0001). Moderate or severe aortic regurgitation rates were similar between redo-TAVR and native-TAVR groups at 1 year (1.8% vs. 3.3%, p = 0.18). Death or stroke after redo-TAVR were not significantly affected by the timing of redo-TAVR (before or after 1 year of index TAVR), or by index transcatheter valve type (balloon-expandable or non–balloon-expandable).
Conclusions:
The authors report that redo-TAVR with balloon-expandable valves effectively treated dysfunction of the index TAVR procedure with low procedural complication rates.
Perspective:
This national registry of consecutive patients undergoing TAVR with balloon-expandable transcatheter valves (STS/ACC TVT Registry) suggests that redo-TAVR with balloon-expandable transcatheter valves was feasible for treating both aortic stenosis and aortic regurgitation with low rates of procedural complications. Furthermore, the clinical outcomes at 30 days and 1 year were affected by the underlying baseline surgical risk, but not by early or late timing of redo-TAVR or the type of the first transcatheter valve implant. Overall, these data suggest that redo-TAVR with balloon-expandable transcatheter valves might be a reasonable option for the treatment of failed transcatheter valves in selected patients who are deemed appropriate for redo-TAVR by a multidisciplinary heart team.
Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound
Keywords: Aortic Valve Insufficiency, Aortic Valve Stenosis, Cardiac Surgical Procedures, Echocardiography, Geriatrics, Heart Valve Diseases, Heart Valve Prosthesis, Patient Care Team, Secondary Prevention, STS/ACC TVT Registry, Transcatheter Aortic Valve Replacement
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