TAVR failure mechanisms (structural vs. non-structural) did not impact reintervention type or clinical outcomes, despite structural failures having a longer time to reintervention.
Does the mechanism of TAVR failure (SVD vs NSVD) impact clinical outcomes after reintervention?
TAVR failure mechanism (SVD vs NSVD) influences reintervention timing but does not affect clinical outcomes after reintervention.
Absolute Event Rate: 0% vs 0%
BACKGROUND: As transcatheter aortic valve replacement (TAVR) expands to patients with longer life expectancy, the impact of failure mechanisms on outcomes of TAVR-explant and redo-TAVR remains uncertain. We sought to evaluate outcomes of TAVR reintervention based on the failure mechanism of the index transcatheter aortic valve. METHODS: From 2009 to 2022, 553 patients from 29 centers in the EXPLANTORREDO-TAVR registry underwent TAVR-explant or redo-TAVR for transcatheter aortic valve failure. Patients with endocarditis were excluded. Patients with structural valve deterioration (SVD, N=224 64.9%) were compared with those with nonstructural valve dysfunction (NSVD, N=121 35.1%), comprising paravalvular leak (86.0%) and prosthesis-patient mismatch (14.0%). Outcomes were assessed at 30 days and 1 year. RESULTS: Mean age was 75.6±9.3 years, with 42% women. There were no differences in reintervention type between groups (redo-TAVR in 58.0% SVD versus 49.6% NSVD; TAVR-explant: 42.0% versus 50.4%; P=0.14). Compared with NSVD, SVD was the predominant mode of failure in balloon-expandable valves (50.7% versus 24.8%; P<0.001), had a longer time to reintervention (50.7 versus 5.5 months; P<0.001), and favored non-balloon-expandable valves at redo-TAVR (56.9% versus 33.3%; P=0.003). Mortality at 30 days and 1 year did not differ significantly between SVD and NSVD for either redo-TAVR (30 days: 3.2% versus 1.7%, P=1.00; 1 year: 18.0% versus 12.0%; P=0.47) or TAVR-explant (30 days: 16.3% versus 12.1%, P=0.63; 1 year: 40.0% versus 29.5%; P=0.39). There were also no differences in risk-adjusted 3-year cumulative mortality between groups (redo-TAVR: HR, 1.30 95% CI, 0.68-2.46, P=0.43 ref=NSVD; TAVR-explant: HR, 1.24 95% CI, 0.64-2.41; P=0.53). CONCLUSIONS: SVD and NSVD failures had distinct valve types and reintervention timing, with SVD having a longer time to TAVR reintervention, but the failure mechanism did not impact reintervention type or clinical outcomes.
Penta et al. (Wed,) reported a other. TAVR failure mechanisms (structural vs. non-structural) did not impact reintervention type or clinical outcomes, despite structural failures having a longer time to reintervention.