Luca Testa, Mauro Agnifili, Nicolas M Van Mieghem, Didier Tchétché, Anita W Asgar, Ole De Backer, Azeem Latib, Bernhard Reimers, Giulio Stefanini, Carlo Trani, Antonio Colombo, Francesco Giannini, Antonio Bartorelli, Wojtek Wojakowski, Maciej Dabrowski, Dariusz Jagielak, Adrian P Banning, Rajesh Kharbanda, Raul Moreno, Joachim Schofer, Niels van Royen, Duane Pinto, Antoni Serra, Amit Segev, Arturo Giordano, Nedy Brambilla, Antonio Popolo Rubbio, Matteo Casenghi, Jacopo Oreglia, Federico De Marco, Rudolph Tanja, James M McCabe, Alexander Abizaid, Michiel Voskuil, Rui Teles, Giuseppe Biondi Zoccai, Giovanni Bianchi, Lars Sondergaard, Francesco Bedogni
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引用次数: 4
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has determined a paradigm shift in the treatment of patients with severe aortic stenosis. However, the durability of bioprostheses is still a matter of concern, and little is known about the management of degenerated TAV. We sought to evaluate the outcomes of patients with a degenerated TAV treated by means of a second TAVR.
Methods: The TRANSIT is an international registry that included cases of degenerated TAVR from 28 centers. Among around 40 000 patients treated with TAVR in the participating centers, 172 underwent a second TAVR: 57 (33%) for a mainly stenotic degenerated TAV, 97 (56%) for a mainly regurgitant TAV, and 18 (11%) for a combined degeneration. Overall, the rate of New York Heart Association class III/IV at presentation was 73.5%.
Results: Valve Academic Research Consortium 2 device success rate was 79%, as a consequence of residual gradient (14%) or regurgitation (7%). At 1 month, the overall mortality rate was 2.9%, while rates of new hospitalization and New York Heart Association class III/IV were 3.6% and 7%, respectively, without significant difference across the groups. At 1 year, the overall mortality rate was 10%, while rates of new hospitalization and New York Heart Association class III/IV were 7.6% and 5.8%, respectively, without significant difference across the groups. No cases of valve thrombosis were recorded.
Conclusions: Selected patients with a degenerated TAV may be safely and successfully treated by means of a second TAVR. This finding is of crucial importance for the adoption of the TAVR technology in a lower risk and younger population.
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