Outcomes of Redo Transcatheter Aortic Valve Replacement for the Treatment of Postprocedural and Late Occurrence of Paravalvular Regurgitation and Transcatheter Valve Failure

Abstract

T ranscatheter aortic valve replacement (TAVR) is an established alternative for patients with severe aortic stenosis. 1 There is a growing body of evidence demonstrating the durability of current TAVR devices out to 5 years. 2-5 However, it is well known that transcatheter aortic valves (TAVs) can degenerate in a manner similar to surgical bioprostheses. Background-Transcatheter aortic valves can degenerate in a manner similar to surgical bioprostheses. 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. (Circ Cardiovasc Interv. 2016;9:e003930.

Incidence of Long‐Term Structural Valve Dysfunction and Bioprosthetic Valve Failure After Transcatheter Aortic Valve Replacement

“…As the duration of implanted THVs increases, valve durability and dysfunction become more crucial issues 15. No significant increases in mean THV gradient or cases of structural valve deterioration were reported during the 5‐year follow‐up of the PARTNER (Placement of Aortic Transcatheter Valves) I trial 7…”

Transcatheter Aortic Valve Replacement in Intermediate‐ and Low‐Risk Patients

“…In the meantime, as more patients undergo TAVR, THV failure will become more common. TAVR‐in‐TAVR has been shown to be safe, with comparable short‐ and midterm clinical and hemodynamic outcomes to valve‐in‐valve TAVR for failed surgical bioprostheses 20, 21…”

Hot Topics in Transcatheter Aortic Valve Implantation

“…In this particular subset, life expectancy is expected to exceed that of initial candidates to TAVI (i.e., elderly and very elderly patients at high or prohibitive surgical risk), which raised the question of long-term prosthesis durability of crucial importance. If THV durability up to 5 years is already a quite well-established reality, with very low rates of structural valve dysfunction demonstrated in large and methodologically rigorous studies [24][25][26], data on clinical outcomes and THV integrity at longer term follow-up remain extremely scarce. No significant increases in mean THV gradient or cases of structural valve deterioration were reported during the 5-year follow-up of the Placement of Aortic Transcatheter Valves (PARTNER) I trial [3].…”