Resultados a Largo Plazo de Reemplazo Transcatéter de Válvula Aórtica Repetido vs. Explante de Válvula Aórtica...

Comparative durability of subsequent procedures after transcatheter aortic valve replacement (TAVR) remains unclear. This study aims to assess long-term outcomes of Repeat TAVR versus TAVR Explant for bioprosthetic valve dysfunction post-TAVR.

Medicare beneficiaries undergoing aortic valve reintervention after index TAVR (January 2012 - December 2020) were categorized as Repeat TAVR or TAVR Explant. Exclusion criteria included endocarditis or reintervention during the same admission. Primary outcome was 5-year mortality; secondary outcomes included major adverse cardiovascular events (death, pacemaker placement, major bleeding, stroke, AKI, cardiac arrest). Time-to-event analyses utilized Kaplan-Meier. Adjusted outcomes were assessed via 1:1 propensity matching.

Among 1,172 patients undergoing reintervention after TAVR, 70.6% had Repeat TAVR and 29.4% had TAVR Explant. Repeat TAVR patients were older, more often female, with higher Charlson Comorbidity score (all p<0.05). Median follow-up was 29.2 months (27.7 months Repeat TAVR, 32.3 months TAVR Explant). In the propensity-matched cohorts, 30- and 90-day mortality was higher after TAVR Explant, but Kaplan-Meier estimated cumulative mortality was lower in TAVR Explant at 3 and 5 years (all p<0.001). Survival curves crossed at ∼9months, after which TAVR Explant maintained a persistent advantage. The hazard ratio over the entire follow-up was 0.61 (95% CI 0.49-0.75, p<0.001). Similar survival patterns were observed across Charlson comorbidity stratification and after excluding concomitant procedures.

Although Repeat TAVR showed lower short-term mortality, long-term outcomes favored TAVR Explant. These findings suggest that among Medicare beneficiaries experiencing TAVR failure, there is a subset of patients who could benefit from TAVR Explant over Repeat TAVR.