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Redo transcatheter aortic valve implantation (TAVI) is feasible for dysfunctional TAVI prostheses, showing high device success rates. However, this patient group faces high mortality, underscoring the need for careful consideration in redo TAVI procedures.

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Prosthetic Valve Technology

Background:

  • Transcatheter aortic valve implantation (TAVI) is a standard treatment for severe aortic stenosis.
  • Dysfunction of TAVI prostheses necessitates reintervention, often referred to as redo TAVI.
  • Paravalvular regurgitation and stenosis are primary causes of TAVI prosthesis failure.

Purpose of the Study:

  • To evaluate the feasibility and early clinical outcomes of redo TAVI procedures.
  • To identify the main indications for redo TAVI.
  • To assess device success and prosthesis-patient mismatch in redo TAVI.

Main Methods:

  • Retrospective analysis of 19 redo TAVI procedures performed between 2011 and 2015.
  • Data collection included patient demographics, EuroSCORE, time since index TAVI, and failure modes.
  • Assessment of device success, post-interventional gradients, and prosthesis-patient mismatch (PPM).

Main Results:

  • Redo TAVI was performed in 19 patients (mean age 78 years, 68% male).
  • Paravalvular regurgitation was the most common indication (16/19 patients).
  • Device success was high (89%), with low post-procedural gradients and no severe PPM. One-year mortality was 33%.

Conclusions:

  • Redo TAVI is a feasible option for managing dysfunctional TAVI prostheses.
  • Paravalvular regurgitation is the leading reason for repeat TAVI.
  • While technically successful, redo TAVI is associated with high mortality in comorbid patients.