TAVR-in-TAVR achieved a 91.3% technical success rate and 68% 30-day device success, demonstrating feasibility despite varying outcomes across supra-annular and intra-annular combinations.
Does prosthetic configuration (supra-annular vs intra-annular combinations) affect safety, hemodynamic performance, and clinical outcomes in patients undergoing TAVR-in-TAVR?
TAVR-in-TAVR is a feasible strategy with high technical success, though device success is limited by residual gradients, and outcomes vary numerically by prosthesis combination.
Absolute Event Rate: 0% vs 0%
Background: As transcatheter aortic valve replacement (TAVR) expands to younger, lower‐risk populations, the need for repeat procedures due to valve degeneration is expected to increase. TAVR‐in‐TAVR has emerged as a feasible strategy, although outcomes across supra‐annular (SAV) and intra‐annular (IAV) valve combinations remain unclear. The PANDORA (Supra‐Annular Versus Intra‐Annular Devices for TAVR‐in‐TAVR) international registry study assessed safety, hemodynamic performance, and clinical outcomes of TAVR‐in‐TAVR according to prosthetic configurations. Methods: From an international multicenter registry (2011–2024), 172 TAVR‐in‐TAVR cases were identified among ≈30 000 TAVR procedures, with a median interval of 1401 days. Patients were stratified into 4 groups: SAV‐IAV (n=32), SAV‐SAV (n=29), IAV‐SAV (n=74), and IAV‐IAV (n=37). Results: CoreValve/Evolut (49.4%) and Edwards SAPIEN (35.5%) were the most frequent index prostheses, whereas the second valve was mainly Edwards SAPIEN (60.5%), followed by Evolut (35.5%) and Myval/Octacor (4.0%). Structural valve deterioration was the leading failure mechanism (77.9%), while nonstructural valve deterioration dysfunction, alone or combined with structural valve deterioration, occurred in 40.7%. Overall Valve Academic Research Consortium 3 technical success was 91.3%, numerically highest in SAV‐IAV and IAV‐SAV ( P =0.090). Thirty‐day device success was 68%, also higher in SAV‐IAV (75.9%, P =0.301), mainly influenced by elevated residual gradients (≥20 mm Hg in 12.7%) and the 30‐day mortality rate (7.3%). At 1 year, the IAV‐IAV group showed the numerically lowest freedom from death and heart failure hospitalization (76.1%, P =0.734). Male sex and chronic kidney disease independently predicted death at follow‐up. Conclusions: TAVR‐in‐TAVR is feasible with generally favorable outcomes, although clinical and procedural profiles vary by the different prosthesis combinations. These findings highlight the need for further studies to refine device selection strategies.
Rubbio et al. (Thu,) reported a other. TAVR-in-TAVR achieved a 91.3% technical success rate and 68% 30-day device success, demonstrating feasibility despite varying outcomes across supra-annular and intra-annular combinations.