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Landes U, Morelli O, Danenberg H, Sathananthan J, Backer OD, 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. [PMID: 35700856 DOI: 10.1016/j.ijcard.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022]
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.
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Affiliation(s)
- Uri Landes
- Edith Wolfson Medical Center, Holon, and Tel-Aviv University, Israel..
| | - Olga Morelli
- Rabin medical center, Tel-Aviv University, Israel
| | - Haim Danenberg
- Edith Wolfson Medical Center, Holon, and Tel-Aviv University, Israel
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation Centre for Heart Valve Innovation St Paul's and Vancouver General Hospital Vancouver, Canada
| | - Ole De Backer
- Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | | | - Sung-Han Yoon
- Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California., United States of America
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California., United States of America
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | | | - Antonio Mangieri
- Invasive Cardiology, Humanitas Clinical and Research Center, IRCCS and department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | | | | | - Marco Barbanti
- A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | | | | | | | | | | | | | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Azeem Latib
- Montefiore Medical Center, New York, NY, USA
| | - Rebecca Godfrey
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Lisa Manevich
- Edith Wolfson Medical Center, Holon, and Tel-Aviv University, Israel
| | | | - Tamim M Nazif
- Columbia University Medical Center, New York, NY, USA
| | - Martin B Leon
- Columbia University Medical Center, New York, NY, USA
| | - John G Webb
- Centre for Cardiovascular Innovation Centre for Heart Valve Innovation St Paul's and Vancouver General Hospital Vancouver, Canada
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