OR07-7
Repeat Intervention after Transcatheter Aortic Valve Replacement: Clinical Characteristics and Outcomes of Redo Transcatheter Aortic Valve Replacement and Surgical Explant
Gustavo Mendez Hirata, MD, The Carl & Edyth Lindner Center for Research & Education at The Christ Hospital, Cincinnati, OH
Gustavo Mendez Hirata, MD1, Christian Schmidt, MS1, Geoffrey A Answini, MD2, J. Michael Smith, MD2, Saad Hasan, MD2, Jeffrey M Griffin, MD2, Robert Dowling, MD2, Dean J. Kereiakes, M.D., MSCAI2, Puvi N. Seshiah, M.D.2, Joseph Choo, MD2, Zaid Alirhayim, MD3 and Santiago Garcia, M.D., FSCAI2, (1)The Carl & Edyth Lindner Center for Research & Education at The Christ Hospital, Cincinnati, OH, (2)The Christ Hospital Health Network, Cincinnati, OH, (3)The Carl & Edyth Lindner Center for Research & Education at The Christ Hospital, Mason, OH
Keywords: Structural Heart Disease (SHD) and TAVI/TAVR/Aortic Valve
Background:
Transcatheter
aortic valves (TAV) are subject to degeneration and repeat intervention. TAV are increasingly used in clinical practice but there is paucity of data regarding repeat interventions.
Methods:
We sought to describe and compare clinical characteristics and outcomes of repeat transcatheter aortic valve replacement (TAV in TAV) versus TAVR surgical explant procedures. We included all patients undergoing a repeat procedure after an index TAVR at The Christ Hospital Network (Cincinnati, OH) from 01/2015 to 08/2023. All clinical events were defined according to VARC 3 criteria.
Results:
A total of 31 patients (25 TAV in TAV and 6 surgical explants) were included in the analysis. The median [IQR] time from index TAVR to TAV in TAV was 5.02 years [1.01-7.12] and 2.55 years [1.36-3.20] for surgical explants (p=0.386). Baseline characteristics and outcomes are presented in the
Table. Patients undergoing TAV in TAV were more likely to have structural valve deterioration (60%) whereas patients undergoing surgical explants were more likely to present with infective endocarditis (50%). Major adverse cardiac event rates were similar at discharge and at 30 days (p=1.000 and 0.207). TAV in TAV technical and 30-day device success rates were 88% (n=22) and 84% (n=21), respectively. Kansas City Cardiomyopathy Questionnaire overall score improved at 30 days and 1 year (p
Trend<0.001) after TAV in TAV.
Conclusions
:
In appropriately selected patients, TAV in TAV and surgical explant are associated with acceptable safety and efficacy. The mechanism of failure of the TAVR valve is an important determinant of subsequent treatment.
