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Multicenter Study
. 2016 Sep;9(9):e003930.
doi: 10.1161/CIRCINTERVENTIONS.116.003930.

Outcomes of Redo Transcatheter Aortic Valve Replacement for the Treatment of Postprocedural and Late Occurrence of Paravalvular Regurgitation and Transcatheter Valve Failure

Marco Barbanti  1 , John G Webb  2 , Claudia Tamburino  2 , Nicolas M Van Mieghem  2 , Raj R Makkar  2 , Nicolò Piazza  2 , Azeem Latib  2 , Jan-Malte Sinning  2 , Kim Won-Keun  2 , Sabine Bleiziffer  2 , Francesco Bedogni  2 , Samir Kapadia  2 , Didier Tchetche  2 , Josep Rodés-Cabau  2 , Claudia Fiorina  2 , Luis Nombela-Franco  2 , Federico De Marco  2 , Peter P de Jaegere  2 , Tarun Chakravarty  2 , Beatriz Vaquerizo  2 , Antonio Colombo  2 , Lars Svensson  2 , Rüdiger Lange  2 , Georg Nickenig  2 , Helge Möllmann  2 , Thomas Walther  2 , Francesco Della Rosa  2 , Yacine Elhmidi  2 , Danny Dvir  2 , Nedy Brambilla  2 , Sebastiano Immè  2 , Carmelo Sgroi  2 , Simona Gulino  2 , Denise Todaro  2 , Gerlando Pilato  2 , Anna Sonia Petronio  2 , Corrado Tamburino  2
Affiliations
Multicenter Study

Outcomes of Redo Transcatheter Aortic Valve Replacement for the Treatment of Postprocedural and Late Occurrence of Paravalvular Regurgitation and Transcatheter Valve Failure

Marco Barbanti et al. Circ Cardiovasc Interv. 2016 Sep.

Abstract

Background: Transcatheter aortic valves can degenerate in a manner similar to surgical bioprostheses.

Methods and results: Clinical and echocardiographic outcomes of patients who underwent redo transcatheter aortic valve replacement (TAVR) procedures >2 weeks post procedure were collected from 14 centers. Among 13 876 patients, 50 (0.4%) underwent redo TAVR procedure at participating centers. Indications for redo TAVR were moderate-severe prosthetic aortic valve stenosis (n=10, 21.7%), moderate-severe central prosthetic aortic valve regurgitation (n=13, 28.3%), and moderate-severe paraprosthetic aortic valve regurgitation (n=25, 50.0%). The index TAVR was most commonly a Medtronic CoreValve (N=38, 76.0%), followed by Edwards SAPIEN-type valves (n=12, 24.0%) and Portico (n=1, 2.0%). The redo TAVR device was most commonly a CoreValve/Evolut R (n=29, 58.0%), followed by a SAPIEN-type valve (n=20,40.0%) or a Boston Lotus valve (n=1, 2.0%). In 40 patients (80.0%), redo TAVR was performed using the identical device type or that of the succeeding generation. Valve performance was uniformly good after redo TAVR (mean transvalvular gradient post redo TAVR: 12.5±6.1 mm Hg). At hospital discharge, all patients remained alive, with 1 nondisabling stroke (2.0%) and 1 life-threatening bleed (2.0%). Permanent pacemaker implantation was required in 3 out of 35 patients without a prior pacemaker (8.6%). Late survival was 85.1% at a median follow-up of 1589 days (range: 31-3775) after index TAVR and 635 days (range: 8-2460) after redo TAVR.

Conclusions: Redo TAVR for the treatment of postprocedural and late occurrence of paravalvular regurgitation and transcatheter aortic valve prosthesis failure seems to be safe, and it is associated with favorable acute and midterm clinical and echocardiographic outcomes.

Keywords: aortic regurgitation; aortic stenosis; degeneration; prosthesis; transcatheter aortic valve; transcatheter aortic valve replacement.

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