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. 2023 Apr 17;44(15):1331-1339.
doi: 10.1093/eurheartj/ehad146.

Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation: prognostic implications

Uri Landes  1 , Aviram Hochstadt  1 , Lisa Manevich  1 , John G Webb  2 , Janarthanan Sathananthan  2 , Horst Sievert  3 , Kerstin Piayda  3 , Martin B Leon  4 , Tamim M Nazif  4 , David Blusztein  4 , David Hildick-Smith  5 , Chris Pavitt  5 , Holger Thiele  6 , Mohamed Abdel-Wahab  6 , Nicolas M Van Mieghem  7 , Rik Adrichem  7 , Lars Sondergaard  8 , Ole De Backer  8 , Raj R Makkar  9 , Ofir Koren  9 , Thomas Pilgrim  10 , Taishi Okuno  10 , Ran Kornowski  11 , Pablo Codner  11 , Ariel Finkelstein  12 , Itamar Loewenstein  12 , Israel Barbash  13 , Amir Sharon  13 , Federico De Marco  14 , Matteo Montorfano  15 , Nicola Buzzatti  15 , Azeem Latib  16 , Andrea Scotti  16 , Won-Keun Kim  17 , Christian Hamm  17 , Luis Nombela Franco  18 , Antonio Mangieri  19 , Wolfgang H Schoels  20 , Marco Barbanti  21 , Matjaz Bunc  22 , Myriama Akodad  23 , Ronen Rubinshtein  1 , Haim Danenberg  1
Affiliations

Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation: prognostic implications

Uri Landes et al. Eur Heart J. .

Abstract

Aims: Paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) is associated with increased morbidity and mortality. The effect of transcatheter interventions to treat PVR after the index TAVI was investigated.

Methods and results: A registry of consecutive patients who underwent transcatheter intervention for ≥ moderate PVR after the index TAVI at 22 centers. The principal outcomes were residual aortic regurgitation (AR) and mortality at 1 year after PVR treatment. A total of 201 patients were identified: 87 (43%) underwent redo-TAVI, 79 (39%) plug closure, and 35 (18%) balloon valvuloplasty. Median TAVI-to-re-intervention time was 207 (35; 765) days. The failed valve was self-expanding in 129 (63.9%) patients. The most frequent devices utilized were a Sapien 3 valve for redo-TAVI (55, 64%), an AVP II as plug (33, 42%), and a True balloon for valvuloplasty (20, 56%). At 30 days, AR ≥ moderate persisted in 33 (17.4%) patients: 8 (9.9%) after redo-TAVI, 18 (25.9%) after plug, and 7 (21.9%) after valvuloplasty (P = 0.036). Overall mortality was 10 (5.0%) at 30 days and 29 (14.4%) at 1 year: 0, 8 (10.1%), and 2 (5.7%) at 30 days (P = 0.010) and 11 (12.6%), 14 (17.7%), and 4 (11.4%) at 1 year (P = 0.418), after redo-TAVI, plug, and valvuloplasty, respectively. Regardless of treatment strategy, patients in whom AR was reduced to ≤ mild had lower mortality at 1 year compared with those with AR persisting ≥ moderate [11 (8.0%) vs. 6 (21.4%); P = 0.007].

Conclusion: This study describes the efficacy of transcatheter treatments for PVR after TAVI. Patients in whom PVR was successfully reduced had better prognosis. The selection of patients and the optimal PVR treatment modality require further investigation.

Keywords: Paravalvular regurgitation (PVR); Plug; Redo-TAVI; TAVI; Valvuloplasty.

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Conflict of interest statement

Conflict of interest J.G.W.: consultant to, and has received research funding from, Edwards Lifesciences, Abbott Vascular, and Boston Scientific. W-K.K.: proctor or speaker fees from Boston Scientific, Abbott, Edwards Lifesciences, Medtronic, Meril Life Sciences. M.A-W.: received speaker's honoraria and/or consultancy fees on his behalf from Boston Scientific and Medtronic. M.B.: consultant for Edwards Lifesciences, Medtronic, and Boston Scientific. L.S.: consultant fees and institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, and Symetis. C.H.: Advisory Board Medtronic. J.M. Sinning: speaker honoraria and research grants from Medtronic, Boston Scientific, and Edwards Lifesciences. J.S.: consultant to Edwards Lifesciences. M. Andreas: proctor/consultant/speaker for Edwards, Abbott, and Medtronic, received institutional grants (Edwards, Abbott, Medtronic, and LSI). Dr. M. Guerrero: research grant support from Abbott Vascular and Edwards Lifesciences. F. Castriota: proctor for Medtronic and Boston Scientific. T.N.: consulting or honoraria from Edwards Lifesciences, Medtronic, and Boston Scientific. Consulting and equity with Venus MedTech. T.P.: research grants from Boston Scientific, Edwards Lifesciences, and Biotronik; speaker fees/consultancy fees from Boston Scientific, Medtronic, Abbott, Biotronik, and HighLife SAS. V.C. Babaliaros: consultant to Edwards Lifesciences and equity in transmural system. M.M.: consultant fee from Abbott, Boston, Kardia, and Medtronic. N.V.M.: institutional research grants and consulting fees from Abbott, Boston Scientific, Medtronic, Daiichi Sankyo, and PulseCath BV and institutional research grant support from Edwards Lifesciences. A.L.: institutional research/grant support from Abbott, Boston Scientific, Medtronic, and Edwards Lifesciences; and personal consulting honoraria from Abbott, Edwards Lifesciences and Medtronic. D.H-S.: proctor and advisory to Boston, Medtronic, Edwards Lifesciences, and Abbott. R.M. received grant support from Edwards Lifesciences Corporation; he is a consultant for Abbott Vascular, Cordis, and Medtronic and holds equity in Entourage Medical. All other authors have no conflict of interest to report in relation with this manuscript.

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