Repeat Transcatheter Aortic Valve Replacement for Transcatheter Prosthesis Dysfunction.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Landes Uri, Webb John G, De Backer Ole, Sondergaard Lars, Abdel-Wahab Mohamed, Crusius Lisa, Kim Won-Keun, Hamm Christian, Buzzatti Nicola, Montorfano Matteo, Ludwig Sebastian, Schofer Niklas, Voigtlaender Lisa, Guerrero Mayra, El Sabbagh Abdallah, Rodés-Cabau Josep, Guimaraes Leonardo, Kornowski Ran, Codner Pablo, Okuno Taishi, Pilgrim Thomas, Fiorina Claudia, Colombo Antonio, Mangieri Antonio, Eltchaninoff Helene, Nombela-Franco Luis, Van Wiechen Maarten P H, Van Mieghem Nicolas M, Tchétché Didier, Schoels Wolfgang H, Kullmer Matthias, Tamburino Corrado, Sinning Jan-Malte, Al-Kassou Baravan, Perlman Gidon Y, Danenberg Haim, Ielasi Alfonso, Fraccaro Chiara, Tarantini Giuseppe, De Marco Federico, Witberg Guy, Redwood Simon R, Lisko John C, Babaliaros Vasilis C, Laine Mika, Nerla Roberto, Castriota Fausto, Finkelstein Ariel, Loewenstein Itamar, Eitan Amnon, Jaffe Ronen, Ruile Philipp, Neumann Franz J, Piazza Nicolo, Alosaimi Hind, Sievert Horst, Sievert Kolja, Russo Marco, Andreas Martin, Bunc Matjaz, Latib Azeem, Govdfrey Rebecca, Hildick-Smith David, Sathananthan Janarthanan, Hensey Mark, Alkhodair Abdullah, Blanke Philipp, Leipsic Jonathon, Wood David A, Nazif Tamim M, Kodali Susheel, Leon Martin B, Barbanti Marco
Аннотация
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.