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Landes, U; Morelli, O; Danenberg, H; Sathananthan, J; De Backer, O; Sondergaard, L; Abdel-Wahab, M; Yoon, SH; Makkar, RR; Thiele, H; Kim, WK; Hamm, C; Guerrero, M; Rodés-Cabau, J; Okuno, T; Pilgrim, T; Mangieri, A; Van Mieghem, NM; Tchétché, D; Schoels, WH; Barbanti, M; Sinning, JM; Ielasi, A; Tarantini, G; De Marco, F; Finkelstein, A; Sievert, H; Andreas, M; Latib, A; Godfrey, R; Hildick-Smith, D; Manevich, L; Kornowski, R; Nazif, TM; Leon, MB; Webb, JG.
Transcatheter aortic valve-in-valve implantation to treat aortic para-valvular regurgitation after TAVI
INT J CARDIOL. 2022; 364: 31-34. Doi: 10.1016/j.ijcard.2022.06.014
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Co-authors Med Uni Graz: Andreas Martin
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Abstract:: Background: Para-valvular regurgitation (PVR) after transcatheter aortic valve (TAV) implantation is associated with increased mortality. Redo-TAVI may be applied to treat PVR, yet with unknown efficacy. We thought to assess redo-TAVI efficacy in reducing PVR using the Redo-TAVI registry (45 centers; 600 TAV-in-TAV cases). Methods: Patients were excluded if redo-TAVI was done urgently (N = 253), for isolated TAV stenosis (N = 107) or if regurgitation location at presentation remained undetermined (N = 123). The study group of patients with PVR (N = 70) were compared against patients with intra-valvular regurgitation (IVR) (N = 41). Echocardiographic examinations of 67 (60%) patients were reassessed in a core-lab for data accuracy validation. Results: Core-lab examination validated the jet location in 66 (98.5%) patients. At 30 days, the rate of residual AR = moderate was 7 (10%) in the PVR cohort vs. 1 (2.4%) in the IVR cohort, p = 0.137. The rate of procedural success was 53 (75.7%) vs. 33 (80.5%), p = 0.561; procedural safety 51 (72.8%) vs. 31 (75.6%), p = 0.727; and mortality 2 (2.9%) vs. 1 (2.4%), p = 0.896 at 30 days and 7 (18.6%) vs. 2 (11.5%), p = 0.671 at 1 year, respectively. Of patients with residual PVR = moderate at 30 days, 5/7 occurred after implanting balloon-expandable in self-expanding TAV and 2/7 after balloon-expandable in balloon-expandable TAV. Conclusions: This study puts in perspective redo-TAVI efficacy and limitations to treat PVR after TAVI. Patient selection for this and other therapies for PVR needs further investigation.
Find related publications in this database (Keywords): TAVI; Para-valvular aortic regurgitation; Para-valvular leak; Redo-TAVI; Valve-in-valve