Transcatheter aortic valve-in-valve implantation to treat aortic para-valvular regurgitation after TAVI.

Landes, Uri; Morelli, Olga; Danenberg, Haim; Sathananthan, Janarthanan; Backer, Ole De; Sondergaard, Lars; Abdel-Wahab, Mohamed; Yoon, Sung-Han; Makkar, Raj R; Thiele, Holger; Kim, Won-Keun; Hamm, Christian; Guerrero, Mayra; Rodés-Cabau, Josep; Okuno, Taishi; Pilgrim, Thomas; Mangieri, Antonio; Van Mieghem, Nicolas M; Tchétché, Didier; Schoels, Wolfgang H; ... (2022). Transcatheter aortic valve-in-valve implantation to treat aortic para-valvular regurgitation after TAVI. International journal of cardiology, 364, pp. 31-34. Elsevier 10.1016/j.ijcard.2022.06.014

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BACKGROUND

Para-valvular regurgitation (PVR) after transcatheter aortic valve (TAV) implantation is associated with increased mortality. Redo-TAVI may be applied to treat PVR, yet with unknown efficacy. We thought to assess redo-TAVI efficacy in reducing PVR using the Redo-TAVI registry (45 centers; 600 TAV-in-TAV cases).

METHODS

Patients were excluded if redo-TAVI was done urgently (N = 253), for isolated TAV stenosis (N = 107) or if regurgitation location at presentation remained undetermined (N = 123). The study group of patients with PVR (N = 70) were compared against patients with intra-valvular regurgitation (IVR) (N = 41). Echocardiographic examinations of 67 (60%) patients were reassessed in a core-lab for data accuracy validation.

RESULTS

Core-lab examination validated the jet location in 66 (98.5%) patients. At 30 days, the rate of residual AR ≥ moderate was 7 (10%) in the PVR cohort vs. 1 (2.4%) in the IVR cohort, p = 0.137. The rate of procedural success was 53 (75.7%) vs. 33 (80.5%), p = 0.561; procedural safety 51 (72.8%) vs. 31 (75.6%), p = 0.727; and mortality 2 (2.9%) vs. 1 (2.4%), p = 0.896 at 30 days and 7 (18.6%) vs. 2 (11.5%), p = 0.671 at 1 year, respectively. Of patients with residual PVR ≥ moderate at 30 days, 5/7 occurred after implanting balloon-expandable in self-expanding TAV and 2/7 after balloon-expandable in balloon-expandable TAV.

CONCLUSIONS

This study puts in perspective redo-TAVI efficacy and limitations to treat PVR after TAVI. Patient selection for this and other therapies for PVR needs further investigation.

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