Death and stroke rates similar to those in patients with a similar clinical profile and predicted risk undergoing TAVR for native aortic valve stenosis
By Lori Solomon HealthDay Reporter
MONDAY, Sept. 11, 2023 (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).
The researchers found that the rates of procedural complications of redo TAVR were low (coronary compression or obstruction: 0.3 percent; intraprocedural death: 0.6 percent; conversion to open heart surgery: 0.5 percent) and overall similar to native TAVR. For death at 30 days (4.7 versus 4.0 percent) or one year (17.5 versus 19.0 percent) and stroke at 30 days (2.0 versus 1.9 percent) or one year (3.2 versus 3.5 percent), there were no significant differences between redo-TAVR and native-TAVR populations, respectively. At one year, redo TAVR reduced aortic valve gradients, although they were higher in the redo-TAVR group versus the native-TAVR group (15 versus 12 mm Hg). Rates of moderate or severe aortic regurgitation did not differ significantly between the redo-TAVR and native-TAVR groups at one year (1.8 versus 3.3 percent). Timing of redo TAVR (before or after one 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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