Author/Editor		Landes, Uri; Webb, John G.; De Backer, Ole; Sondergaard, Lars; Abdel-Wahab, Mohamed; Crusius, Lisa; Kim, Won-Keun; Hamm, Christian; Buzzatti, Nicola; Bunc, Matjaž
Title		Repeat transcatheter aortic valve replacement for transcatheter prosthesis dysfunction
Type		članek
Vol. and No.		Letnik 75Letnik 16
Publication year		2020
Volume		str. 1882-1893
ISSN		0735-1097 - Journal of the American College of Cardiology
Language		eng
Abstract		Background Transcatheter aortic valve replacement (TAVR) use is increasing in patients with longer life expectancy, yet robust data on the durability of transcatheter heart valves (THVs) are limited. Redo-TAVR may play a key strategy intreating patients in whom THVs fail. Objectives The authors sought to examine outcomes following redo-TAVR. Methods The Redo-TAVR registry collected data on consecutive patients who underwent redo-TAVR at 37 centers. Patients were classified as probable TAVR failure or probable THV failure if they presented within or beyond 1 year of their index TAVR, respectively. Results Among 63,876 TAVR procedures, 212 consecutive redo-TAVR procedures were identified (0.33%): 74 within and 138 beyond 1 year of the initial procedure. For these 2 groups, TAVR-to-redo-TAVR time was 68 (38 to 154) days and 5 (3 to 6) years. The indication for redo-TAVR was THV stenosis in 12 (16.2%) and 51 (37.0%) (p=0.002) and regurgitation or combined stenosis-regurgitation in 62 (83.8%) and 86 (62.3%) (p=0.028), respectively. Device successusing VARC-2 criteria was achieved in 180 patients (85.1%); most failures were attributable to high residual gradients (14.1%) or regurgitation (8.9%). At 30-day and 1-year follow-up, residual gradients were 12.6+-7.5 mm Hg and 12.9+-9.0 mm Hg; valve area 1.63+-0.61 cm2 and 1.51+-0.57 cm2; and regurgitation<-mild in 91% and 91%, respectively. Peri-procedural complication rates were low (3 stroke [1.4%], 7 valve malposition [3.3%], 2 coronary obstruction [0.9%], 20new permanent pacemaker [9.6%], no mortality), and symptomatic improvement was substantial. Survival at 30 dayswas 94.6% and 98.5% (p=0.101) and 83.6% and 88.3% (p=0.335) at 1 year for patients presenting with early and late valve dysfunction, respectively. Conclusions Redo-TAVR is a relatively safe and effective option for selected patients with valve dysfunction after TAVR. These results are important for applicability of TAVR in patients with long life expectancy in whom THV durability may be a concern.
Keywords		aortic valve repeat replacement durability of transcatheter heart valves aortna zaklopka ponovno nadomeščanje trajnost transkatetrskih srčnih zaklopk