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. 2020 Apr 28;75(16):1882-1893.
doi: 10.1016/j.jacc.2020.02.051.

Repeat Transcatheter Aortic Valve Replacement for Transcatheter Prosthesis Dysfunction

Uri Landes  1 , John G Webb  2 , Ole De Backer  3 , Lars Sondergaard  3 , Mohamed Abdel-Wahab  4 , Lisa Crusius  4 , Won-Keun Kim  5 , Christian Hamm  5 , Nicola Buzzatti  6 , Matteo Montorfano  6 , Sebastian Ludwig  7 , Niklas Schofer  7 , Lisa Voigtlaender  7 , Mayra Guerrero  8 , Abdallah El Sabbagh  8 , Josep Rodés-Cabau  9 , Leonardo Guimaraes  9 , Ran Kornowski  10 , Pablo Codner  10 , Taishi Okuno  11 , Thomas Pilgrim  11 , Claudia Fiorina  12 , Antonio Colombo  13 , Antonio Mangieri  13 , Helene Eltchaninoff  14 , Luis Nombela-Franco  15 , Maarten P H Van Wiechen  16 , Nicolas M Van Mieghem  16 , Didier Tchétché  17 , Wolfgang H Schoels  18 , Matthias Kullmer  18 , Corrado Tamburino  19 , Jan-Malte Sinning  20 , Baravan Al-Kassou  20 , Gidon Y Perlman  21 , Haim Danenberg  21 , Alfonso Ielasi  22 , Chiara Fraccaro  23 , Giuseppe Tarantini  23 , Federico De Marco  24 , Guy Witberg  25 , Simon R Redwood  26 , John C Lisko  27 , Vasilis C Babaliaros  27 , Mika Laine  28 , Roberto Nerla  29 , Fausto Castriota  29 , Ariel Finkelstein  30 , Itamar Loewenstein  30 , Amnon Eitan  31 , Ronen Jaffe  31 , Philipp Ruile  32 , Franz J Neumann  32 , Nicolo Piazza  33 , Hind Alosaimi  33 , Horst Sievert  34 , Kolja Sievert  34 , Marco Russo  35 , Martin Andreas  35 , Matjaz Bunc  36 , Azeem Latib  37 , Rebecca Govdfrey  38 , David Hildick-Smith  38 , Janarthanan Sathananthan  39 , Mark Hensey  39 , Abdullah Alkhodair  39 , Philipp Blanke  39 , Jonathon Leipsic  39 , David A Wood  39 , Tamim M Nazif  40 , Susheel Kodali  40 , Martin B Leon  40 , Marco Barbanti  41
Affiliations
Free article

Repeat Transcatheter Aortic Valve Replacement for Transcatheter Prosthesis Dysfunction

Uri Landes et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Transcatheter aortic valve replacement (TAVR) use is increasing in patients with longer life expectancy, yet robust data on the durability of transcatheter heart valves (THVs) are limited. Redo-TAVR may play a key strategy in treating patients in whom THVs fail.

Objectives: The authors sought to examine outcomes following redo-TAVR.

Methods: The Redo-TAVR registry collected data on consecutive patients who underwent redo-TAVR at 37 centers. Patients were classified as probable TAVR failure or probable THV failure if they presented within or beyond 1 year of their index TAVR, respectively.

Results: Among 63,876 TAVR procedures, 212 consecutive redo-TAVR procedures were identified (0.33%): 74 within and 138 beyond 1 year of the initial procedure. For these 2 groups, TAVR-to-redo-TAVR time was 68 (38 to 154) days and 5 (3 to 6) years. The indication for redo-TAVR was THV stenosis in 12 (16.2%) and 51 (37.0%) (p = 0.002) and regurgitation or combined stenosis-regurgitation in 62 (83.8%) and 86 (62.3%) (p = 0.028), respectively. Device success using VARC-2 criteria was achieved in 180 patients (85.1%); most failures were attributable to high residual gradients (14.1%) or regurgitation (8.9%). At 30-day and 1-year follow-up, residual gradients were 12.6 ± 7.5 mm Hg and 12.9 ± 9.0 mm Hg; valve area 1.63 ± 0.61 cm2 and 1.51 ± 0.57 cm2; and regurgitation ≤mild in 91% and 91%, respectively. Peri-procedural complication rates were low (3 stroke [1.4%], 7 valve malposition [3.3%], 2 coronary obstruction [0.9%], 20 new permanent pacemaker [9.6%], no mortality), and symptomatic improvement was substantial. Survival at 30 days was 94.6% and 98.5% (p = 0.101) and 83.6% and 88.3% (p = 0.335) at 1 year for patients presenting with early and late valve dysfunction, respectively.

Conclusions: Redo-TAVR is a relatively safe and effective option for selected patients with valve dysfunction after TAVR. These results are important for applicability of TAVR in patients with long life expectancy in whom THV durability may be a concern.

Keywords: durability; transcatheter aortic valve replacement; transcatheter heart valve; valve-in-valve.

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Comment in

  • TAVR in TAVR: The Future Is Now.
    Thourani VH, Edelman JJ, Meduri CU. Thourani VH, et al. J Am Coll Cardiol. 2020 Apr 28;75(16):1894-1896. doi: 10.1016/j.jacc.2020.03.017. J Am Coll Cardiol. 2020. PMID: 32327099 No abstract available.
  • TAVR-in-TAVR?: Don't Bank on It!
    Rogers T, Khan JM, Satler LF, Greenbaum AB, Lederman RJ. Rogers T, et al. J Am Coll Cardiol. 2020 Aug 25;76(8):1003. doi: 10.1016/j.jacc.2020.05.083. J Am Coll Cardiol. 2020. PMID: 32819458 Free PMC article. No abstract available.
  • Coronary Artery Obstruction Risk With Redo TAVR: A Word of Caution.
    Komatsu I, Dvir D, Tang GHL. Komatsu I, et al. J Am Coll Cardiol. 2020 Aug 25;76(8):1004. doi: 10.1016/j.jacc.2020.05.082. J Am Coll Cardiol. 2020. PMID: 32819459 No abstract available.
  • Reply: Redo-TAVR May Not Always Be an Option.
    Landes U, Sathananthan J, Wood D, Webb JG. Landes U, et al. J Am Coll Cardiol. 2020 Aug 25;76(8):1004-1005. doi: 10.1016/j.jacc.2020.06.047. J Am Coll Cardiol. 2020. PMID: 32819460 No abstract available.

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