Redo Transcatheter Aortic Heart Valve Replacement for Transcatheter Valve Dysfunction

Background: The long-term durability of transcatheter heart valves (THV) remains controversial. Redo-transcatheter aortic valve replacement (TAVR) may play a key strategy in treating patients with degenerated THV.

Objectives: To examine clinical and echocardiographic outcomes following redo-TAVR.

Methods: The Redo-TAVR global registry collected data on consecutive patients who underwent redo-TAVR at 37 centers. Patients undergoing redo-TAVR within 1 year of their index TAVR were excluded.

Results: Among 63,876 TAVR procedures, 211 redo-TAVR were identified and 138 included. Patient age was 79.2 ± 9.0 years, STS 6.9 ± 5.9%, 62% were males. TAVR to redo-TAVR time was 1 to 11.6 [median 5 (3; 6)] years, post redo-TAVR follow-up was 15 (3; 36) months. Indications involved THV stenosis 51 (37%), combined stenosis-regurgitation 45 (32.6%) and regurgitation 41 (29.7%). Primary and redo-THVs were self-expandable in half of the cases. Using VARC-2 criteria, redo-TAVR was successful in 118 (85.5%) patients, most failures were attributable to high residual gradients or regurgitation. At 30 day and 1 year follow-up, residual gradients were 11.9 ± 8.1 and 11.1 ± 6.4 mmHg; valve area 1.7 ± 0.7 and 1.7 ± 0.6 cm²; and regurgitation ≤ mild in 83% and 83%, respectively. Periprocedural complication rates were low and symptomatic improvement was significant at 30 day and persistent at 1 year. Survival was 98.5% at 30 day and 88.3% at 1 year.

Conclusions: Redo-TAVR is associated with favorable outcomes in selected patients with THV dysfunction. These results are important for applicability of TAVR in patients with long life expectancy.