Outcomes of Unplanned Additional Transcatheter Aortic Valve Deployment

Significant residual aortic insufficiency (AI), paravalvular leak, and an embolized valve after transcatheter aortic valve replacement (TAVR) may require an additional TAVR valve as an unplanned intervention. However, the outcome of an unplanned additional valve deployment is scarcely documented. We evaluated postoperative outcomes in patients with unplanned additional TAVR valve deployment.

Between January 2021 and September 2023, 1131 patients underwent TAVR at Albany Medical Center Hospital (Albany, NY). A balloon-expanding valve was placed in 98.3% of patients, whereas a self-expanding valve was used in 1.7%.

An additional unplanned transfemoral transcatheter aortic valve deployment was required in 0.01% (9 of 1131) of the patients (0.07% [7 of 1112] in the balloon-expanding valve group and 10.5% [2 of 19] in the self-expanding valve group. The indication for an additional valve was severe AI, valve embolization, or improper position of the first valve (66.7%, 22.2%, and 11.1%, respectively). AI was resolved in all patients except for 1, who died after second valve deployment for severe AI. Permanent pacemaker placement after a second TAVR was required in 2 patients (22%). The 30-day mortality was 16.7% (1 of 6) in the severe AI group, 0% (0 of 2) in the valve embolization group, and 0% (0 of 1) in the improper position group. The mean follow-up term was 5.3 (6.4) months. No aortic valve reintervention was performed in the follow-up term. The cumulative survival rates in patients with unplanned additional valve deployment were 88.9% at 1 month and 71.1% at 12 months.

The outcome of unplanned second valve deployment in TAVR was satisfactory. However, unplanned additional valve deployment may increase the risk of permanent pacemaker placement.