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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Impact of Initial Valve Type on Reintervention for TAVR Failure: From the EXPLANTORREDO-TAVR International Registry
Syed Zaid1, Tsuyoshi Kaneko2, Ole De Backer3
1Baylor College of Medicine, Michael E DeBakey VA Medical Center, Houston, TX (S.Z.).
Background:
As transcatheter aortic valve replacement (TAVR) expands to younger patients, there is limited data on the impact of TAV type on outcomes of TAVR-explant and redo-TAVR for TAVR failure. We sought to compare outcomes of reintervention for failed balloon-expandable valves (BEV) versus self-expanding valves (SEV).
Methods:
From May 2009 to February 2022, 553 patients from 29 centers in the international EXPLANTORREDO-TAVR registry underwent redo-TAVR or TAVR-explant for TAVR failure during a separate admission from index TAVR. Mechanically expanding valves and explantation for endocarditis were excluded. 158 (41.4%) failed-BEV were compared with 224 (58.6%) failed-SEV, and outcomes were reported at 30 days and 1 year.
Results:
Mean age at reintervention was 75.5±9.3 years, and 40.6% were female. Failed-BEV had higher proportion of structural valve deterioration (73.4% versus 46.1% in failed-SEV; P<0.001) and prosthesis-patient mismatch (12.3% versus 5.5%, P=0.022) and fewer paravalvular leak (18.2% versus 41.1%; P<0.001) paralleling a longer time-to-reintervention (41.8 versus 19.7 months; P<0.001). Reintervention strategy was nearly identical between groups (redo TAVR 54.4% failed-BEV versus 53.6% failed-SEV; TAVR-explant 45.6% versus 46.4%; P=0.92), with cross-platform redo-TAVR favored in both groups (58.1% of failed-BEV received SEV; 59.2% of failed-SEV received BEV; P=0.016). Compared with failed-SEV, reintervention for failed-BEV had similar mortality at 30 days (8.7% versus 8.0%; P=0.85) and 1 year (24.3% versus 21.5%; P=0.65), with no differences in risk-adjusted 3-year cumulative mortality when stratified by reintervention type (redo TAVR: adjusted hazard ratio, 1.15 [0.61-2.20]; ref: failed-BEV); TAVR-explant: adjusted hazard ratio, 0.84 [0.46-1.54]).
Conclusions:
Failed-BEV and failed-SEV showed distinct failure mechanisms and timing of reintervention, but initial valve type did not impact reintervention strategy or survival after redo-TAVR or TAVR-explant.