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Updated: Jun 13, 2026
06:04
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Risk and Outcomes of Reintervention After Transcatheter Aortic Valve Implantation
Sundos Alabbadi1, Nana Toyoda2, Shinobu Itagaki2
1Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
The Annals of Thoracic Surgery
|June 11, 2026
Summary
The risk of reintervention after transcatheter aortic valve implantation (TAVI) increases significantly over time, especially after seven years. While mortality risk is similar across intervals, early reinterventions are linked to higher heart failure hospitalization rates.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Services Research
Background:
- Growing concerns regarding the long-term durability and failure management of transcatheter aortic valve implantation (TAVI).
- Need to understand the evolving risk and outcomes associated with reintervention following TAVI procedures.
Purpose of the Study:
- To assess the time-varying risk of reintervention after TAVI in a large Medicare patient cohort.
- To evaluate the outcomes, including mortality and heart failure hospitalizations, associated with TAVI reinterventions across different time intervals.
Main Methods:
- Utilized Bayesian survival analysis on Medicare data (2013-2022) for 324,701 TAVI patients, focusing on 2,387 reinterventions.
- Identified three distinct time intervals based on changes in reintervention hazard rates.
- Employed multivariable Bayesian models to analyze associations between survival, heart failure hospitalizations, and time intervals, controlling for confounders.
Main Results:
- Three reintervention intervals identified: early (<3.5 years), mid-term (3.5-<7 years), and late (≥7 years).
- Hazard rate of reintervention increased significantly over time, from 0.26% early to 0.98% late.
- Valve stenosis was the most common cause for reintervention, increasing with time. Valve-in-valve procedures became more frequent in later intervals. Mortality risk at 30 days and 1 year was similar across intervals, but early reinterventions showed a higher adjusted risk of heart failure hospitalization.
Conclusions:
- The hazard of TAVI reintervention escalates over time, with a notable increase occurring after seven years.
- While mortality post-reintervention is consistent across time intervals, early reinterventions are associated with increased heart failure hospitalization risk.
- Clinical management and post-TAVI surveillance strategies should be tailored to address the time-dependent increase in reintervention risk.
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