Outcomes of Redo Transcatheter Aortic Valve Replacement for the Treatment of Postprocedural and Late Occurrence of Paravalvular Regurgitation and Transcatheter Valve Failure.
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Barbanti Marco, Webb John G, Tamburino Claudia, Van Mieghem Nicolas M, Makkar Raj R, Piazza Nicolò, Latib Azeem, Sinning Jan-Malte, Won-Keun Kim, Bleiziffer Sabine, Bedogni Francesco, Kapadia Samir, Tchetche Didier, Rodés-Cabau Josep, Fiorina Claudia, Nombela-Franco Luis, De Marco Federico, de Jaegere Peter P, Chakravarty Tarun, Vaquerizo Beatriz, Colombo Antonio, Svensson Lars, Lange Rüdiger, Nickenig Georg, Möllmann Helge, Walther Thomas, Della Rosa Francesco, Elhmidi Yacine, Dvir Danny, Brambilla Nedy, Immè Sebastiano, Sgroi Carmelo, Gulino Simona, Todaro Denise, Pilato Gerlando, Petronio Anna Sonia, Tamburino Corrado
Аннотация
METHODS AND RESULTS: Clinical and echocardiographic outcomes of patients who underwent redo transcatheter aortic valve replacement (TAVR) procedures >2 weeks post procedure were collected from 14 centers. Among 13 876 patients, 50 (0.4%) underwent redo TAVR procedure at participating centers. Indications for redo TAVR were moderate-severe prosthetic aortic valve stenosis (n=10, 21.7%), moderate-severe central prosthetic aortic valve regurgitation (n=13, 28.3%), and moderate-severe paraprosthetic aortic valve regurgitation (n=25, 50.0%). The index TAVR was most commonly a Medtronic CoreValve (N=38, 76.0%), followed by Edwards SAPIEN-type valves (n=12, 24.0%) and Portico (n=1, 2.0%). The redo TAVR device was most commonly a CoreValve/Evolut R (n=29, 58.0%), followed by a SAPIEN-type valve (n=20,40.0%) or a Boston Lotus valve (n=1, 2.0%). In 40 patients (80.0%), redo TAVR was performed using the identical device type or that of the succeeding generation. Valve performance was uniformly good after redo TAVR (mean transvalvular gradient post redo TAVR: 12.5±6.1 mm Hg). At hospital discharge, all patients remained alive, with 1 nondisabling stroke (2.0%) and 1 life-threatening bleed (2.0%). Permanent pacemaker implantation was required in 3 out of 35 patients without a prior pacemaker (8.6%). Late survival was 85.1% at a median follow-up of 1589 days (range: 31-3775) after index TAVR and 635 days (range: 8-2460) after redo TAVR.
CONCLUSIONS: Redo TAVR for the treatment of postprocedural and late occurrence of paravalvular regurgitation and transcatheter aortic valve prosthesis failure seems to be safe, and it is associated with favorable acute and midterm clinical and echocardiographic outcomes.