Repeat Transcatheter Aortic Valve Replacement for Transcatheter Prosthesis Dysfunction
Key result
Redo-TAVR for prosthesis dysfunction achieves ~85% device success with similar survival regardless of failure timing.
- P=0.335
- n=212
Why the study?
TAVR is increasingly used in patients with longer life expectancy, but data on transcatheter heart valve durability are limited and outcomes following redo-TAVR needed examination.
Does redo-TAVR provide safe and effective outcomes in patients with transcatheter prosthesis dysfunction?
Key Points
- To evaluate the procedural and clinical outcomes of repeat transcatheter aortic valve replacement (redo-TAVR) in patients with failing transcatheter heart valves.
- Multicenter registry analysis of N=212 consecutive redo-TAVR procedures identified across 37 centers from a total cohort of 63,876 TAVR procedures (0.33%).
- Patients were categorized based on timing of valve failure: probable TAVR failure presenting within 1 year of index procedure (n=74) versus probable transcatheter heart valve failure presenting beyond 1 year (n=138).
- Device success by VARC-2 criteria was achieved in 85.1% (180/212) of patients, with low peri-procedural complication rates (0% mortality, 1.4% stroke, 0.9% coronary obstruction, and 9.6% new pacemaker implantation).
- Echocardiographic outcomes showed stable residual mean gradients of 12.6 ± 7.5 mm Hg at 30 days and 12.9 ± 9.0 mm Hg at 1 year, with mild or less regurgitation in 91% of patients at both time points.
- Survival was 94.6% vs 98.5% at 30 days (p = 0.101) and 83.6% vs 88.3% at 1 year (p = 0.335) for patients presenting with early versus late valve dysfunction, respectively.
Study Design
Type
Observational (n=212)
Multicenter
Yes
Structured PICO
Does redo-TAVR provide safe and effective outcomes in patients with transcatheter prosthesis dysfunction?
P
Population
212 consecutive patients who underwent redo-TAVR for transcatheter heart valve failure at 37 centers, followed for up to 1 year.
E
Exposure
Redo-TAVR (Repeat Transcatheter Aortic Valve Replacement)
O
Outcome
Device success using VARC-2 criteriacomposite
Main Result
Absolute Event Rate: 83.6% vs 88.3%
p-value: p=0.335
Redo-TAVR is a safe and effective treatment strategy for patients experiencing transcatheter heart valve dysfunction, achieving high device success and low peri-procedural mortality.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We would hope that TAVR valves would last an average of 10 years, but in these patients, the average time that the valve lasted was just 2-and-a-half years. So this says something about this patient population. It's difficult to apply it to patients who have late failure.”
“If we can learn how to do redo TAVR on the older, sicker patients, then hopefully those lessons will carry over to our younger patients and our lower-risk patients.”
Implication
Registry data support redo-TAVR feasibility in selected patients; hypothesis-generating for younger, lower-risk cohorts.
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.
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Cite This Study
Landes et al. (2020) conducted an observational in Transcatheter Prosthesis Dysfunction (n=212). Redo-TAVR for early valve dysfunction vs. Redo-TAVR for late valve dysfunction was evaluated on Survival at 1 year (p=0.335). Redo-TAVR for transcatheter prosthesis dysfunction achieved 85.1% device success, with 1-year survival of 83.6% and 88.3% for early and late valve dysfunction, respectively (p=0.335).