Procedural Success of TAV-in-TAV vs TAV-in-SAV

Transcatheter aortic valve replacement in failed TAVs was found to be associated with greater procedural success than TAV in failed surgical aortic valve.

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).

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