Transcatheter aortic valve (TAV) replacement (TAVR) in failed TAVs (TAV-in-TAV) was found to be associated with greater procedural success than TAV in failed surgical aortic valve (TAV-in-SAV), according to study results published in the Journal for the American College of Cardiologists.

Patients (mean age, 80 years, IQR, 75-84 years) undergoing a second TAVR due to dysfunctional TAVs at 37 centers in Europe, North America, and the Middle East after February 2019 were enrolled in the Redo-TAVR registry. Patients underwent TAV-in-TAV (n=212) or TAV-in-SAV (n=595) procedures and were evaluated for procedural success, clinical characteristics, and mortality at a median follow-up of 425 days (interquartile range [IQR], 76-1073 days).

 Patients who received TAV-in-TAV vs TAV-in-SAV were more frail (P <.001), had lower aortic valve mean gradient (P <.001), higher aortic regurgitation (P <.001), less aortic stenosis (P =.002), fewer previous bypass surgeries (P =.025), lower left ventricular ejection fraction (P =.026), more peripheral heart disease (P =.026), and higher estimated glomerular filtration rate (P =.028).


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After propensity score matching, no significant differences were observed at baseline between the 2 group (n=165 in each group).

Procedural success was achieved in 72.7% of TAV-in-TAV and in 62.4% of TAV-in-SAV procedures (P =.045). The higher rate of treatment success in the TAV-in-TAV vs TAV-in-SAV group was driven by lower rates of ectopic valve deployment (0.6% vs 3.3%, respectively; P =.081), conversion to open heart surgery (0% vs 1.8%, respectively; P =.082), coronary obstruction (1.2% vs 4.2%, respectively; P =.091), and residual high (³20 mmHg) aortic gradient (14.6% vs 21.5%, respectively; P =.095).

At 30 days, TAV-in-TAV vs TAV-in-SAV recipients had lower mean residual gradients (12.6±5.2 vs 14.9±5.2 mmHg, respectively; P =.011), larger aortic valve areas (1.55±0.5 vs 1.37±0.5 cm2, respectively; P =.040), and a greater degree of aortic regurgitation (36.1% vs 17.2%, respectively; P =.003) which was maintained at the 1-year follow-up (36.2% vs 12.1%, respectively; P =.001).

Patients who received TAV-in-TAV and TAV-in-SAV had comparable rates of major bleeding (10.3% vs 5.2%, respectively; P =.061), acute kidney injury (4.2% vs 1.3%; P =.091, respectively), permanent pacemaker placement (10.9% vs 7.8%, respectively; P =.251), and residual aortic regurgitation (8.4% vs 4.8%, respectively; P =.4629).

Mortality rates at 1 year were 11.9% and 10.2% among patients who received TAV-in-TAV and TAV-in-SAV, respectively (P =.633).

This study was limited by its observational design and small sample size after propensity matching.

“More study is needed to improve TAV-in-TAV outcomes as well as the upstream management of patients with [aortic stenosis] with long life expectancy,” concluded the study authors.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Landes U, Sathananthan J, Witberg G, et al. Transcatheter Replacement of Transcatheter Versus Surgically Implanted Aortic Valve Bioprostheses. J Am Coll Cardiol. 2021;77:1-14. doi:10.1016/j.jacc.2020.10.053