Background

Despite the rapid adoption of transcatheter aortic valve replacement since its approval, the frequency and outcomes of aortic valve reintervention after transcatheter aortic valve replacement are poorly understood.

Methods

Valve reinterventions, either surgical transcatheter aortic valve explantation or repeat transcatheter aortic valve replacement, between 2012 and 2019 were queried using the Society of Thoracic Surgeons Database and the Transcatheter Valve Therapy Registry through the Michigan Statewide quality collaborative. The reintervention frequency and clinical outcomes including observed-to-expected mortality ratio using Society of Thoracic Surgeons Predicted Risk of Mortality were reviewed.

Results

Among 9694 transcatheter aortic valve replacement recipients, a total of 87 patients (0.90%) received a reintervention, consisting of 34 transcatheter aortic valve explants and 53 repeat transcatheter aortic valve replacement procedures. The transcatheter aortic valve explant group demonstrated a higher Society of Thoracic Surgeons Predicted Risk of Mortality. Reintervention cases increased from 0 in 2012 and 2013 to 26 in 2019. The proportion of transcatheter aortic valve explants among all reinterventions increased and was 65% in 2019. Self-expandable devices had a higher reintervention rate than balloon-expandable devices secondary to a higher transcatheter aortic valve explant frequency (0.58% [23/3957] vs 0.19% [11/5737]; P = .001), whereas repeat transcatheter aortic valve replacement rates were similar (0.61% [24/3957] vs 0.51% [29/5737]; P = .51). Among patients with transcatheter aortic valve explants, contraindications to repeat transcatheter aortic valve replacement included unfavorable anatomy (75%), need for other cardiac surgery (29%), other structural issues by transcatheter aortic valve device (18%), and endocarditis (12%). For transcatheter aortic valve explant and repeat transcatheter aortic valve replacement, the 30-day mortality was 15% and 2% (P = .032) and the observed-to-expected mortality ratio was 1.8 and 0.3 (P = .018), respectively.

Conclusions

Aortic valve reintervention remains rare but is increasing. The clinical impact of surgical device explantation was substantial, and the proportion of transcatheter aortic valve explants was significantly higher in patients with a self-expandable device.

中文翻译：

---

经导管主动脉生物瓣膜失败患者的主动脉瓣再介入治疗：全州经验

背景

尽管自批准以来经导管主动脉瓣置换术得到迅速采用，但对经导管主动脉瓣置换术后主动脉瓣再介入治疗的频率和结果知之甚少。

方法

2012 年至 2019 年间，通过密歇根州质量合作组织，使用胸外科医师学会数据库和经导管瓣膜治疗登记处查询了瓣膜再干预，无论是外科经导管主动脉瓣移植术还是重复经导管主动脉瓣置换术。回顾了再干预频率和临床结果，包括使用胸外科医师协会预测的死亡率风险观察到的预期死亡率。

结果

在 9694 名经导管主动脉瓣置换术接受者中，共有 87 名患者 (0.90%) 接受了再干预，包括 34 例经导管主动脉瓣移植术和 53 例重复经导管主动脉瓣置换术。经导管主动脉瓣外植体组表现出更高的胸外科医师协会预测的死亡率风险。再介入病例从 2012 年和 2013 年的 0 例增加到 2019 年的 26 例。经导管主动脉瓣移植占所有再介入的比例增加，2019 年为 65%。经导管主动脉瓣外植体频率（0.58% [23/3957] vs 0.19% [11/5737]；P = .001)，而重复经导管主动脉瓣置换率相似 (0.61% [24/3957] vs 0.51% [29/5737]；P = . 51)。在接受经导管主动脉瓣移植的患者中，重复经导管主动脉瓣置换术的禁忌症包括不利的解剖结构 (75%)、需要进行其他心脏手术 (29%)、经导管主动脉瓣装置存在其他结构问题 (18%) 和心内膜炎 (12) %)。对于经导管主动脉瓣外植体和重复经导管主动脉瓣置换术，30 天死亡率分别为 15% 和 2% ( P  = .032)，观察死亡率与预期死亡率的比率分别为 1.8 和 0.3 ( P  =  .018 ) .

结论

主动脉瓣再介入术仍然很少见，但正在增加。手术装置移植的临床影响很大，使用自扩张装置的患者经导管主动脉瓣移植的比例明显更高。