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Feasibility and Procedural Considerations of Balloon-Expandable TAVR in Patients With Prior Endovascular Aortic Stent
Iad Alhallak1, Alexander Mills2, Beau Bequeaith1
1Department of Cardiovascular Disease, McGovern Medical School at UTHealth Houston, Houston, Texas, USA.
Objectives:
To evaluate the feasibility and short-term outcomes of transcatheter aortic valve replacement (TAVR) using balloon-expandable Sapien valves in patients with prior endovascular aortic stent grafts.
Methods:
We conducted a single-center, retrospective study of 23 patients with prior endovascular aortic stent grafts who underwent TAVR between 2012 and 2025 using Sapien platform balloon-expandable valves. Descriptive statistics and univariate logistic regression analysis were used to characterize and identify outcomes of peri-procedural complications.
Results:
Transfemoral access was used in 87% of cases, and valve deployment was successful in all patients without aortic injuries or graft-related complications during the procedural and up to 30-day post-procedure period. Median length of stay was 3 days, and there were no deaths up to 30-days. Post-procedural events were infrequent and included new-onset atrial fibrillation (n = 2), transient hemodialysis (n = 1), pleural effusion (n = 1), and stroke (n = 1). In exploratory analyses limited by the small number of events, older age (OR 1.27, 95% CI 1.04-1.71) and higher baseline mean aortic-valve gradient (OR 1.24, 95% CI 1.06-1.76) were associated with periprocedural events.
Conclusions:
The complications observed in our cohort are general outcomes associated with TAVR, instead of graft-associated outcomes. Balloon-expandable TAVR is technically safe and feasible in patients with prior endovascular aortic stent grafts when performed at experienced centers.