Redo-TAVR a safe, effective option for patients with valve dysfunction

Repeat transcatheter aortic valve replacement (redo-TAVR) is relatively safe and effective, making it a feasible alternative for patients with valve dysfunction following TAVR, suggests a study.

Data on consecutive patients who underwent redo-TAVR at 37 centres were obtained from the Redo-TAVR registry. The authors classified patients as probable TAVR failure or probable transcatheter heart valve (THV) failure if they presented within or beyond 1 year of their index TAVR, respectively.

Of the 63,876 TAVR procedures identified, 212 (0.33 percent) were consecutive redo-TAVR: 74 within and 138 beyond 1 year of the initial procedure. TAVR-to-redo-TAVR time was 68 (38 to 154) days for within and 5 (3 to 6) years for beyond 1 year of index procedure.

The indications for redo-TAVR in the two groups were THV stenosis in 12 (16.2 percent) and 51 (37.0 percent; p=0.002) and regurgitation or combined stenosis–regurgitation in 62 (83.8 percent) and 86 (62.3 percent; p=0.028), respectively.

Using the VARC-2 criteria, 180 patients (85.1 percent) achieved device success. Most failures were due to high residual gradients (14.1 percent) or regurgitation (8.9 percent). Residual gradients were 12.6±7.5 at 30-day and 12.9±9.0 mm Hg at 1-year follow-up. The corresponding valve areas were 1.63±0.61 and 1.51±0.57 cm², while ≤mild regurgitation occurred in 91 percent and 91 percent, respectively.

Rates of peri-procedural complication were low (three strokes, 1.4 percent; seven valve malpositions, 3.3 percent; two coronary obstructions, 0.9 percent; 20 new permanent pacemakers, 9.6 percent; and zero deaths). There was substantial symptomatic improvement as well. Survival was 94.6 percent and 98.5 percent at 30 days (p=0.101) and 83.6 percent and 88.3 percent at 1 year (p=0.335) for patients presenting with early and late valve dysfunction, respectively.

“These results are important for applicability of TAVR in patients with long life expectancy in whom THV durability may be a concern,” the authors said.