Syed Zaid, Tsuyoshi Kaneko, Ole De Backer, Sachin S Goel, Paolo Denti, Thomas Modine, Tamim N Nazif, Martin B Leon, Michael J Mack, Vinayak N Bapat, Gilbert H L Tang
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引用次数: 0
Abstract
Background: As transcatheter aortic valve replacement (TAVR) expands to younger patients, there is limited data on the impact of TAV type on outcomes of TAVR-explant and redo-TAVR for TAVR failure. We sought to compare outcomes of reintervention for failed balloon-expandable valves (BEV) versus self-expanding valves (SEV).
Methods: From May 2009 to February 2022, 553 patients from 29 centers in the international EXPLANTORREDO-TAVR registry underwent redo-TAVR or TAVR-explant for TAVR failure during a separate admission from index TAVR. Mechanically expanding valves and explantation for endocarditis were excluded. 158 (41.4%) failed-BEV were compared with 224 (58.6%) failed-SEV, and outcomes were reported at 30 days and 1 year.
Results: Mean age at reintervention was 75.5±9.3 years, and 40.6% were female. Failed-BEV had higher proportion of structural valve deterioration (73.4% versus 46.1% in failed-SEV; P<0.001) and prosthesis-patient mismatch (12.3% versus 5.5%, P=0.022) and fewer paravalvular leak (18.2% versus 41.1%; P<0.001) paralleling a longer time-to-reintervention (41.8 versus 19.7 months; P<0.001). Reintervention strategy was nearly identical between groups (redo TAVR 54.4% failed-BEV versus 53.6% failed-SEV; TAVR-explant 45.6% versus 46.4%; P=0.92), with cross-platform redo-TAVR favored in both groups (58.1% of failed-BEV received SEV; 59.2% of failed-SEV received BEV; P=0.016). Compared with failed-SEV, reintervention for failed-BEV had similar mortality at 30 days (8.7% versus 8.0%; P=0.85) and 1 year (24.3% versus 21.5%; P=0.65), with no differences in risk-adjusted 3-year cumulative mortality when stratified by reintervention type (redo TAVR: adjusted hazard ratio, 1.15 [0.61-2.20]; ref: failed-BEV); TAVR-explant: adjusted hazard ratio, 0.84 [0.46-1.54]).
Conclusions: Failed-BEV and failed-SEV showed distinct failure mechanisms and timing of reintervention, but initial valve type did not impact reintervention strategy or survival after redo-TAVR or TAVR-explant.
期刊介绍：
Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
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