Key result
Rescue THV-in-THV (required in 26 of 2,588 TAVI patients) yielded comparable two-year survival to non-THV-in-THV cases, while its usage decreased from 2.6% in 2013 to 0.6% in 2017.
Why the study?
Midterm outcomes of the rescue THV-in-THV procedure to bail out TAVI complications have been poorly defined.
Does the rescue THV-in-THV procedure provide comparable midterm survival and valve function compared to TAVI without rescue THV-in-THV in patients undergoing TAVI?
Cohort (n=2,588)
Yes
Does the rescue THV-in-THV procedure provide comparable midterm survival and valve function compared to TAVI without rescue THV-in-THV in patients undergoing TAVI?
Rescue THV-in-THV during TAVI is a feasible bailout strategy with comparable midterm survival and valve function to uncomplicated TAVI, despite higher periprocedural complication rates.
Rescue THV-in-THV may aid bailout in select TAVI cases; leaves open need for prospective data on safety and durability.
OBJECTIVES: To confirm whether the rescue transcatheter heart valve in the transcatheter heart valve (THV-in-THV) procedure is effective and feasible, we aimed to assess the midterm outcomes following rescue THV-in-THV procedures. The trends in the usage of the rescue THV-in-THV procedure at the time of transcatheter aortic valve implantation (TAVI) have also been explored. BACKGROUND: Midterm outcomes of the rescue THV-in-THV procedure have been poorly defined, though it is popular as an effective method to bail-out some complications in TAVI. METHODS: We reviewed data from the Optimized transCathEter vAlvular iNtervention-Transcatheter Aortic Valve Implantation (OCEAN-TAVI) registry and compared the outcomes of TAVI with rescue THV-in-THV and TAVI without rescue THV-in-THV. We also examined the annual rates of rescue THV-in-THV procedures in all the TAVI procedures between 2013 and 2017. RESULTS: Among 2,588 patients who underwent TAVI, 26 patients have required rescue THV-in-THV for valve malposition (n = 23) or severe transvalvular regurgitation because of stuck THV leaflets (n = 3). Three cases needed an open conversion, and two died in the hospital. The rates of new permanent pacemaker implantation, acute kidney injury, and stroke were higher in the THV-in-THV group. A two-year cumulative survival and echocardiographic outcomes succeeding rescue THV-in-THV procedure were comparable to non-THV-in-THV cases. The rate of rescue THV-in-THV procedure lessened from 2.6% in 2013 to 0.6% in 2017. CONCLUSIONS: The rescue THV-in-THV procedure is an effective and feasible option for THV malpositioning and stuck valve. It has given a comparable survival and a stable valve function over midterm observation periods.
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Hibino et al. (2020) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=2,588). Rescue THV-in-THV procedure vs. TAVI without rescue THV-in-THV was evaluated on Two-year cumulative survival and echocardiographic outcomes. Rescue THV-in-THV (required in 26 of 2,588 TAVI patients) yielded comparable two-year survival to non-THV-in-THV cases, while its usage decreased from 2.6% in 2013 to 0.6% in 2017.
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