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HealthDay News — Redo transcatheter aortic valve replacement (TAVR) procedures are as safe and effective as native TAVR in select patients, according to a study published online Aug. 31 in The Lancet.
Raj R. Makkar, M.D., from Cedars-Sinai Medical Center in Los Angeles, and colleagues assessed the safety and efficacy of redo TAVR in a national registry. The analysis included all consecutive patients in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry (Nov. 9, 2011, to Dec. 30, 2022) who underwent TAVR with balloon-expandable valves in either failed transcatheter heart valves (redo TAVR; 1,320 patients) or native aortic valves (native TAVR; 349,271 patients).
Researchers found that the rates of procedural complications of redo TAVR were low (coronary compression or obstruction: 0.3%; intraprocedural death: 0.6%; conversion to open heart surgery: 0.5%) and overall similar to native TAVR. For death at 30 days (4.7 vs 4.0%) or 1 year (17.5 vs 19.0%) and stroke at 30 days (2.0 vs 1.9%) or 1 year (3.2 vs 3.5%), there were no significant differences between redo-TAVR and native-TAVR populations, respectively. At 1 year, redo TAVR reduced aortic valve gradients, although they were higher in the redo-TAVR group vs the native-TAVR group (15 vs 12 mm Hg). Rates of moderate or severe aortic regurgitation did not differ significantly between the redo-TAVR and native-TAVR groups at 1 year (1.8 vs 3.3%). Timing of redo TAVR (before or after 1 year of index TAVR) and index transcatheter valve type (balloon-expandable or non-balloon-expandable) did not significantly affect death or stroke after redo TAVR.
“Redo-TAVR with balloon-expandable valves might be a reasonable treatment for failed TAVR in selected patients,” the authors write.
Edwards Lifesciences funded the study.
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