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April 27, 2020

Registry Investigates Repeat TAVR Procedures for Transcatheter Prosthesis Dysfunction

April 27, 2020—In Journal of the American College of Cardiology (JACC), Uri Landes, MD, et al published findings from the Redo-TAVR registry, which is studying outcomes of repeat transcatheter aortic valve replacement (TAVR) for transcatheter prosthesis dysfunction (2020;75:1882–1893).

TAVR use is increasing in patients with longer life expectancy, but there are limited data on the durability of transcatheter heart valves (THVs). Redo-TAVR may play a key strategy in treating patients in whom THVs fail.

The study concluded that redo-TAVR is a relatively safe and effective option for selected patients with valve dysfunction after TAVR. These results are important for the applicability of TAVR in patients with long life expectancy in whom THV durability may be a concern, stated the investigators.

As summarized in JACC, the Redo-TAVR registry collected data on consecutive patients who underwent redo-TAVR at 37 centers. The investigators identified 212 consecutive redo-TAVR procedures (0.33%) among 63,876 TAVR procedures.

Patients were classified as either “probable TAVR failure’ if they presented within 1 year of their index TAVR (n = 74) or “probable THV failure” if they presented beyond 1 year of their index TAVR (n = 138). TAVR-to-redo-TAVR times were 68 (38 to 154) days and 5 (3 to 6) years, respectively.

In JACC, the investigators reported:

  • The indication for redo-TAVR was THV stenosis in 12 “within-1-year” patients and 51 “beyond-1-year” patients (16.2% vs 37%; P = .002).
  • The indication for redo-TAVR was regurgitation or combined stenosis-regurgitation in 62 “within-1-year” patients and 86 “beyond-1-year” patients (83.8% vs 62.3%; P = .028).

Device success using the Valve Academic Research Consortium-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 mm Hg; valve areas were 1.63 ± 0.61 cm2 and 1.51 ± 0.57 cm2; and regurgitation was ≤ mild in 91% and 91%, respectively.

Periprocedural complication rates were low, with three strokes (1.4%), seven valve malpositions (3.3%), two coronary obstructions (0.9%), 20 new permanent pacemakers (9.6%), and no mortality. Additionally, symptomatic improvement was substantial.

Survival at 30 days was 94.6% and 98.5% (P = .101) and 83.6% and 88.3% (P = .335) at 1 year for patients presenting with early and late valve dysfunction, respectively, reported the Redo-TAVR registry investigators in JACC.

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