Clinical Outcomes of Redo Transcatheter Aortic Valve Replacement According to Computed Tomography Sizing

The optimal sizing strategy for redo transcatheter aortic valve replacement (TAVR) on the basis of computed tomographic (CT) planning is currently debated.

The aim of this study was to describe real-world practice for CT sizing and its impact on clinical outcomes of redo-TAVR, according to Valve Academic Research Consortium 3 definitions.

Consecutive patients undergoing redo-TAVR with preprocedural CT planning were retrospectively analyzed. Measurements of the landing zone (LZ) within the index transcatheter aortic valve (TAV-1) were obtained. The selected size of the second valve (TAV-2) was compared with that suggested by LZ measurements, categorizing patients as LZ concordant (matching size) or LZ discordant (deviating size).

Among 150 patients, TAV-1 compression was observed in 97.3% of cases. Overall, 52% of patients received LZ-discordant TAV-2 sizes, mostly resulting in a larger than recommended TAV-2 with 21.2% (15.8%-24.8%) oversizing to the LZ and 7.1% (3.1%-10.9%) to the annulus. No annular rupture events occurred. Device success at 30 days was 73.3%. Median follow-up was 368 days (Q1-Q3: 96-611 days). The estimated rate of bioprosthetic valve failure at 1 year was 8.7% (95% CI: 3.1%-14.2%), without significant differences between the 2 groups. LZ perimeter <62 mm (HR: 4.19; 95% CI: 1.37-12.8; P = 0.012) and TAV-2 size smaller than the manufacturer sizing range for the aortic annulus (HR: 3.75; 95% CI: 1.25-11.2; P = 0.018) were independent predictors of bioprosthetic valve failure.

In patients undergoing redo-TAVR with preprocedural CT planning, a sizing strategy enabling selective TAV-2 oversizing relative to the LZ was associated with favorable outcomes without increased procedural complications. Larger studies are needed to confirm these findings.