Repeat Interventions After Transcatheter Aortic Valve Replacement: Clinical Characteristics and Outcomes of Redo Transcatheter Aortic Valve Replacement and Surgical Explants

Abstract

Background

Transcatheter aortic valves (TAVs) are subject to degeneration and repeat intervention. TAVs are increasingly used in clinical practice, but there is a paucity of data regarding repeat interventions.

Methods

We sought to describe and compare clinical characteristics and outcomes of TAV in TAV procedures vs. surgical explant procedures after an index transcatheter aortic valve replacement (TAVR) at The Christ Hospital Health Network (Cincinnati, OH) from January 2015 to August 2023.

Results

A total of 1314 patients underwent TAVR procedures during the study period. Of these patients, 31 (2.3%) underwent repeat interventions (25 TAV in TAV and 6 surgical explants) and were included. The median [interquartile range] time from index TAVR to a repeat intervention was 5.02 years [1.01-7.12] for TAV in TAV and 2.55 years [1.36-3.20] for surgical explants (p = 0.386). Patients undergoing TAV in TAV were more likely to have structural valve deterioration (60%), whereas patients undergoing surgical explants were more likely to present with infective endocarditis (50%). Major adverse cardiovascular event rates were similar at discharge (20 vs. 17%, p = 1.00). No mortality events were presented in TAVR explant patients. Two strokes presented in TAVR explant patients, 1 at discharge and 1 at 30 days.

Conclusions

Repeat interventions are uncommon in the first decade after TAVR. In clinical practice, the mechanism of failure of the TAVR valve is an important determinant of subsequent treatment; most patients with structural valve deterioration receive a TAV in TAV procedure, whereas surgical explants are usually reserved for infective endocarditis.