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Multicenter Study
. 2024 Jan;113(1):68-74.
doi: 10.1007/s00392-023-02239-8. Epub 2023 Jun 9.

Features and outcomes of bailout repeat transcatheter aortic valve implantation (TAVI): the Bailout Acute TAVI-in-TAVI to Lessen Events (BATTLE) international registry

Arturo Giordano  1   2 , Nicola Corcione  1   2 , Marco Barbanti  3 , Giuliano Costa  4 , Elena Dipietro  4 , Ignacio J Amat-Santos  5 , Javier Gómez-Herrero  5 , Azeem Latib  6 , Andrea Scotti  6 , Luca Testa  7 , Francesco Bedogni  7 , Andreas Schaefer  8 , Marco Russo  9 , Francesco Musumeci  9 , Paolo Ferraro  1   2 , Alberto Morello  1   2 , Michele Cimmino  1   2 , Michele Albanese  1   2 , Martino Pepe  10 , Salvatore Giordano  11 , Giuseppe Biondi-Zoccai  12   13
Affiliations
Multicenter Study

Features and outcomes of bailout repeat transcatheter aortic valve implantation (TAVI): the Bailout Acute TAVI-in-TAVI to Lessen Events (BATTLE) international registry

Arturo Giordano et al. Clin Res Cardiol. 2024 Jan.

Abstract

Aim: Transcatheter aortic valve implantation (TAVI) is a mainstay in the management of severe aortic stenosis in patients with intermediate to prohibitive surgical risk. When a single TAVI device fails and cannot be retrieved, TAVI-in-TAVI must be performed acutely, but outcomes of bailout TAVI-in-TAVI have been incompletely appraised. We aimed at analyzing patient, procedural and outcome features of patients undergoing bailout TAVI-in-TAVI in a multicenter registry.

Methods: Details of patients undergoing bailout TAVI-in-TAVI, performed acutely or within 24 h of index TAVI, in 6 international high-volume institutions, were collected. For every case provided, 2 same-week consecutive controls (prior TAVI, and subsequent TAVI) were provided. Outcomes of interest were procedural and long-term events, including death, myocardial infarction, stroke, access site complication, major bleeding, and reintervention, and their composite (i.e. major adverse events [MAE]).

Results: A total of 106 patients undergoing bailout TAVI-in-TAVI were included, as well as 212 controls, for a total of 318 individuals. Bailout TAVI-in-TAVI was less common in younger patients, those with higher body mass index, or treated with Portico/Navitor or Sapien devices (all p < 0.05). Bailout TAVI-in-TAVI was associated with higher in-hospital rates of death, emergency surgery, MAE, and permanent pacemaker implantation (all p < 0.05). Long-term follow-up showed that bailout TAVI-in-TAVI was associated with higher rates of death and MAE (both < 0.05). Similar findings were obtained at adjusted analyses (all p < 0.05). However, censoring early events, outlook was not significantly different when comparing the two groups (p = 0.897 for death, and p = 0.645 for MAE).

Conclusions: Bail-out TAVI-in-TAVI is associated with significant early and long-term mortality and morbidity. Thus, meticulous preprocedural planning and sophisticated intraprocedural techniques are of paramount importance to avoid these emergency procedures.

Keywords: Aortic stenosis; Bailout; TAVI-in-TAVI; TAVR-in-TAVR; Transcatheter aortic valve implantation; Transcatheter aortic valve replacement.

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Conflict of interest statement

Giuseppe Biondi-Zoccai has consulted for Amarin, Balmed, Cardionovum, Crannmedical, Endocore Lab, Eukon, Innovheart, Guidotti, Meditrial, Microport, Opsens Medical, Replycare, Teleflex, and Terumo. Azeem Latib has served on Advisory Boards or as a consultant for Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, and Philips. Andreas Schaefer received speaker honoraria from Abbott. Andrea Scotti has served as a consultant for NeoChord. All other authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Summary of inhospital and long-term event rates. MAE major adverse event, TAVI transcatheter aortic valve implantation
Fig. 2
Fig. 2
Failure curves for death and major adverse event, distinguishing events occurring within and after 1 month. TAVI transcatheter aortic valve implantation
See this image and copyright information in PMC

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