Repeat Transcatheter Aortic Valve Replacement for Transcatheter Prosthesis Dysfunction.

Aged Aortic Valve / surgery Aortic Valve Insufficiency / diagnosis Aortic Valve Stenosis / surgery Equipment Failure Analysis Female Global Health Heart Valve Prosthesis / adverse effects Humans Male Outcome Assessment, Health Care Postoperative Complications / diagnosis Registries / statistics & numerical data Reoperation / instrumentation Survival Analysis Symptom Assessment / statistics & numerical data Transcatheter Aortic Valve Replacement / adverse effects

durability transcatheter aortic valve replacement transcatheter heart valve valve-in-valve

Journal

Journal of the American College of Cardiology

ISSN: 1558-3597

Titre abrégé: J Am Coll Cardiol

Pays: United States

ID NLM: 8301365

Informations de publication

Date de publication:
28 04 2020

Historique:

received: 22 11 2019

revised: 15 01 2020

accepted: 14 02 2020

entrez: 25 4 2020

pubmed: 25 4 2020

medline: 2 1 2021

Statut: ppublish

Résumé

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. The authors sought to examine outcomes following redo-TAVR. 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. 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 cm 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.

Sections du résumé

BACKGROUND

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 cm

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.

Identifiants

DOI: 10.1016/j.jacc.2020.02.051 PMID: 32327098

pubmed: 32327098

pii: S0735-1097(20)34458-2

doi: 10.1016/j.jacc.2020.02.051

pii:

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

1882-1893

Commentaires et corrections

Type : CommentIn