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. 2022 Aug 8;15(15):1543-1554.
doi: 10.1016/j.jcin.2022.05.016. Epub 2022 Jul 13.

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

Uri Landes  1 , Ilan Richter  2 , Haim Danenberg  3 , Ran Kornowski  2 , Janarthanan Sathananthan  4 , Ole De Backer  5 , Lars Søndergaard  5 , Mohamed Abdel-Wahab  6 , Sung-Han Yoon  7 , Raj R Makkar  7 , Holger Thiele  6 , Won-Keun Kim  8 , Christian Hamm  8 , Nicola Buzzatti  9 , Matteo Montorfano  9 , Sebastian Ludwig  10 , Niklas Schofer  10 , Lisa Voigtlaender  10 , Mayra Guerrero  11 , Abdallah El Sabbagh  11 , Josep Rodés-Cabau  12 , Jules Mesnier  12 , Taishi Okuno  13 , Thomas Pilgrim  13 , Claudia Fiorina  14 , Antonio Colombo  15 , Antonio Mangieri  15 , Helene Eltchaninoff  16 , Luis Nombela-Franco  17 , Maarten P H Van Wiechen  18 , Nicolas M Van Mieghem  18 , Didier Tchétché  19 , Wolfgang H Schoels  20 , Matthias Kullmer  20 , Marco Barbanti  21 , Corrado Tamburino  21 , Jan-Malte Sinning  22 , Baravan Al-Kassou  22 , Gidon Y Perlman  23 , Alfonso Ielasi  24 , Chiara Fraccaro  25 , Giuseppe Tarantini  25 , Federico De Marco  26 , Guy Witberg  2 , Simon R Redwood  27 , John C Lisko  28 , Vasilis C Babaliaros  28 , Mika Laine  29 , Roberto Nerla  30 , Ariel Finkelstein  31 , Amnon Eitan  32 , Ronen Jaffe  32 , Philipp Ruile  33 , Franz J Neumann  33 , Nicolo Piazza  34 , Horst Sievert  35 , Kolja Sievert  35 , Marco Russo  36 , Martin Andreas  36 , Matjaz Bunc  37 , Azeem Latib  38 , Sharon Bruoha  38 , Rebecca Godfrey  39 , David Hildick-Smith  39 , Israel Barbash  40 , Amit Segev  40 , Pál Maurovich-Horvat  41 , Balint Szilveszter  41 , Konstantinos Spargias  42 , Dionisis Aravadinos  42 , Tamim M Nazif  43 , Martin B Leon  43 , John G Webb  4
Affiliations
Free article

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

Uri Landes et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: 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.

Objectives: 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.

Methods: 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]).

Results: 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).

Conclusions: 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.

Keywords: TAVR; balloon-expandable valve; redo TAVR; self-expanding valve; valve-in-valve.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Webb is a consultant to and has received research funding from Edwards Lifesciences, Abbott Vascular, and Boston Scientific. Dr Kim is a proctor for and has received speaker fees from Boston Scientific, Abbott, Edwards Lifesciences, and Medtronic. Dr Abdel-Wahab has received speaker honoraria and/or consultancy fees to the hospital on his behalf from Boston Scientific and Medtronic. Dr Barbanti is a consultant for Edwards Lifesciences; and is an advisory board member for Biotronik. Dr Søndergaard has received consulting fees and institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, and Symetis. Dr Redwood is a proctor for and has received lecture fees from Edwards Lifesciences. Dr Hamm is an advisory board member for Medtronic. Dr Sinning has received speaker honoraria and research grants from Medtronic, Boston Scientific, and Edwards Lifesciences. Dr Sathananthan is a consultant to Edwards Lifesciences. Dr Schofer has received speaker fees and travel compensation from Boston Scientific; and has received travel compensation from Edwards Lifesciences and Abbott/St. Jude Medical. Dr Andreas is a proctor, consultant, and speaker for Edwards Lifesciences, Abbott, and Medtronic; and has received institutional grants from Edwards Lifesciences, Abbott, Medtronic, and LSI. Dr Guerrero has received research grant support from Abbott Vascular and Edwards Lifesciences. Dr Castriota is a proctor for Medtronic and Boston Scientific. Dr Nazif is a consultant for or has received honoraria from Edwards Lifesciences, Medtronic, Boston Scientific, Biotrace, and Baylis Medical; and is a consultant for and holds equity in Venus Medtech. Dr Pilgrim has received research grants from Boston Scientific, Edwards Lifesciences, and Biotronik; and has received speaker fees from Boston Scientific and Biotronik. Dr Babaliaros is a consultant to Edwards Lifesciences; and holds equity in Transmural Systems. Dr Van Mieghem has received institutional research grants and consulting fees from Abbott, Boston Scientific, Medtronic, Daiichi Sankyo, and PulseCath; and has received institutional research grant support from Edwards Lifesciences. Dr Latib has received institutional research and grant support from Abbott, Boston Scientific, Medtronic, and Edwards Lifesciences; and has received personal consulting honoraria from Abbott, Edwards Lifesciences, and Medtronic. Dr Hildick-Smith is a proctor and adviser for Boston Scientific, Medtronic, and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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