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Redo-TAVR with balloon-expandable valves: outcomes from a national registry

27 Nov 2023

In light of the growing number of patients undergoing transcatheter aortic valve replacement (TAVR), there is an increasing demand for data regarding the management of failed TAVR procedures, including the possibility of a repeat TAVR intervention. In a recent study published in the Lancet, researchers evaluated the safety and effectiveness of redo-TAVR, focusing on its performance within a national registry.

This research encompassed all consecutive patients registered in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry from November 9, 2011, to December 30, 2022, who had undergone TAVR with balloon-expandable valves either for failed transcatheter heart valves (redo-TAVR) or for native aortic valves (native-TAVR). Among a total of 350,591 patients (1,320 in the redo-TAVR group and 349,271 in the native-TAVR group), the analysis focused on 1,320 pairs of patients who were well-matched in terms of propensity for redo-TAVR or native-TAVR.

The study revealed that redo-TAVR had relatively low rates of procedural complications, which were comparable to those observed in native-TAVR procedures. No significant disparities were found in the rates of death at 30 days (4.7% vs. 4.0%, p=0.36) or one year (17.5% vs. 19.0%, p=0.57), as well as stroke at 30 days (2.0% vs. 1.9%, p=0.84) or one year (3.2% vs. 3.5%, p=0.80) between the redo-TAVR and native-TAVR populations.

Moreover, redo-TAVR resulted in a reduction of aortic valve gradients at one year, although these gradients were slightly higher in the redo-TAVR group compared to the native-TAVR group (15 mm Hg vs. 12 mm Hg; p<0.0001). Notably, the rates of moderate or severe aortic regurgitation at one year were similar in both the redo-TAVR and native-TAVR groups (1.8% vs. 3.3%, p=0.18). The timing of redo-TAVR (whether performed before or after one year of the index TAVR) and the type of index transcatheter valve (balloon-expandable or non-balloon-expandable) did not significantly impact the rates of death or stroke after redo-TAVR.

In summary, the study indicated that redo-TAVR using balloon-expandable valves effectively addresses dysfunction following the initial TAVR procedure with low rates of procedural complications, and it yields death and stroke rates similar to those observed in patients with comparable clinical profiles and predicted risks undergoing TAVR for native aortic valve stenosis. The authors concluded that redo-TAVR with balloon-expandable valves, may potentially represent a reasonable treatment option for selected patients with failed TAVR.

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Original article: Makkar et al. Lancet. 2023 Aug 31:S0140-6736(23)01636-7.

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