Outcomes of Redo Transcatheter Aortic Valve Replacement According to the Initial and Subsequent Valve Type.
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Landes Uri, Richter Ilan, Danenberg Haim, Kornowski Ran, Sathananthan Janarthanan, De Backer Ole, Søndergaard Lars, Abdel-Wahab Mohamed, Yoon Sung-Han, Makkar Raj R, Thiele Holger, Kim Won-Keun, Hamm Christian, Buzzatti Nicola, Montorfano Matteo, Ludwig Sebastian, Schofer Niklas, Voigtlaender Lisa, Guerrero Mayra, El Sabbagh Abdallah, Rodés-Cabau Josep, Mesnier Jules, 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, Barbanti Marco, Tamburino Corrado, Sinning Jan-Malte, Al-Kassou Baravan, Perlman Gidon Y, Ielasi Alfonso, Fraccaro Chiara, Tarantini Giuseppe, De Marco Federico, Witberg Guy, Redwood Simon R, Lisko John C, Babaliaros Vasilis C, Laine Mika, Nerla Roberto, Finkelstein Ariel, Eitan Amnon, Jaffe Ronen, Ruile Philipp, Neumann Franz J, Piazza Nicolo, Sievert Horst, Sievert Kolja, Russo Marco, Andreas Martin, Bunc Matjaz, Latib Azeem, Bruoha Sharon, Godfrey Rebecca, Hildick-Smith David, Barbash Israel, Segev Amit, Maurovich-Horvat Pál, Szilveszter Balint, Spargias Konstantinos, Aravadinos Dionisis, Nazif Tamim M, Leon Martin B, Webb John G
Аннотация
OBJECTIVES: The purpose of this study was to better inform prosthesis selection, TAV-in-TAV outcomes were assessed according to the type of initial and subsequent TAV.
METHODS: Patients from the Redo-TAVR registry were analyzed using propensity weighting according to their initial valve type (bTAV [n = 115] vs sTAV [n = 106]) and subsequent valve type (bTAV [n = 130] vs sTAV [n = 91]).
RESULTS: Patients with failed bTAVs presented later (vs sTAV) (4.9 ± 2.1 years vs 3.7 ± 2.3 years; P < 0.001), with smaller effective orifice area (1.0 ± 0.7 cm2 vs 1.3 ± 0.8 cm2; P = 0.018) and less frequent dominant regurgitation (16.2% vs 47.3%; P < 0.001). Mortality at 30 days was 2.3% (TAV-in-bTAV) vs 0% (TAV-in-sTAV) (P = 0.499) and 1.7% (bTAV-in-TAV) vs 1.0% (sTAV-in-TAV) (P = 0.612); procedural safety was 72.6% (TAV-in-bTAV) vs 71.2% (TAV-in-sTAV) (P = 0.817) and 73.2% (bTAV-in-TAV) vs 76.5% (sTAV-in-TAV) (P = 0.590). Device success was similar according to initial valve type but higher with subsequent sTAV vs bTAV (77.2% vs 64.3%; P = 0.045), primarily because of lower residual gradients (10.3 mm Hg [8.9-11.7 mm Hg] vs 15.2 mm Hg [13.2-17.1 mm Hg]; P < 0.001). Residual regurgitation (moderate or greater) was similar after bTAV-in-TAV and sTAV-in-TAV (5.7%) and nominally higher after TAV-in-bTAV (9.1%) vs TAV-in-sTAV (4.4%) (P = 0.176).
CONCLUSIONS: In selected patients, no association was observed between TAV type and redo TAVR safety or mortality, yet subsequent sTAV was associated with higher device success because of lower redo gradients. These findings are preliminary, and more data are needed to guide valve choice for redo TAVR.