Outcomes of Redo Transcatheter Aortic Valve Replacement According to the Initial and Subsequent Valve Type,JACC: Cardiovascular Interventions

当前位置： X-MOL 学术 › JACC Cardiovasc. Inte. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Outcomes of Redo Transcatheter Aortic Valve Replacement According to the Initial and Subsequent Valve Type
JACC: Cardiovascular Interventions ( IF 11.7 ) Pub Date : 2022-07-13 , DOI: 10.1016/j.jcin.2022.05.016
Uri Landes ₁ , Ilan Richter ₂ , Haim Danenberg ₁ , Ran Kornowski ₂ , Janarthanan Sathananthan ₃ , Ole De Backer ₄ , Lars Søndergaard ₄ , Mohamed Abdel-Wahab ₅ , Sung-Han Yoon ₆ , Raj R Makkar ₆ , Holger Thiele ₅ , Won-Keun Kim ₇ , Christian Hamm ₇ , Nicola Buzzatti ₈ , Matteo Montorfano ₈ , Sebastian Ludwig ₉ , Niklas Schofer ₉ , Lisa Voigtlaender ₉ , Mayra Guerrero ₁₀ , Abdallah El Sabbagh ₁₀ , Josep Rodés-Cabau ₁₁ , Jules Mesnier ₁₁ , Taishi Okuno ₁₂ , Thomas Pilgrim ₁₂ , Claudia Fiorina ₁₃ , Antonio Colombo ₁₄ , Antonio Mangieri ₁₄ , Helene Eltchaninoff ₁₅ , Luis Nombela-Franco ₁₆ , Maarten P H Van Wiechen ₁₇ , Nicolas M Van Mieghem ₁₇ , Didier Tchétché ₁₈ , Wolfgang H Schoels ₁₉ , Matthias Kullmer ₁₉ , Marco Barbanti ₂₀ , Corrado Tamburino ₂₀ , Jan-Malte Sinning ₂₁ , Baravan Al-Kassou ₂₁ , Gidon Y Perlman ₂₂ , Alfonso Ielasi ₂₃ , Chiara Fraccaro ₂₄ , Giuseppe Tarantini ₂₄ , Federico De Marco ₂₅ , Guy Witberg ₂ , Simon R Redwood ₂₆ , John C Lisko ₂₇ , Vasilis C Babaliaros ₂₇ , Mika Laine ₂₈ , Roberto Nerla ₂₉ , Ariel Finkelstein ₃₀ , Amnon Eitan ₃₁ , Ronen Jaffe ₃₁ , Philipp Ruile ₃₂ , Franz J Neumann ₃₂ , Nicolo Piazza ₃₃ , Horst Sievert ₃₄ , Kolja Sievert ₃₄ , Marco Russo ₃₅ , Martin Andreas ₃₅ , Matjaz Bunc ₃₆ , Azeem Latib ₃₇ , Sharon Bruoha ₃₇ , Rebecca Godfrey ₃₈ , David Hildick-Smith ₃₈ , Israel Barbash ₃₉ , Amit Segev ₃₉ , Pál Maurovich-Horvat ₄₀ , Balint Szilveszter ₄₀ , Konstantinos Spargias ₄₁ , Dionisis Aravadinos ₄₁ , Tamim M Nazif ₄₂ , Martin B Leon ₄₂ , John G Webb ₃

Affiliation

Edith Wolfson Medical Center, Holon, Israel; Tel-Aviv University, Tel-Aviv, Israel.
Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
Centre for Cardiovascular Innovation, Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada.
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California, USA.
Kerckhoff Heart Center, Bad Nauheim, Germany.
San Raffaele Scientific Institute, Milan, Italy.
University Heart Center Hamburg, Hamburg, Germany.
Mayo Clinic, Rochester, Minnesota, USA.
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
University Hospital of Bern, Bern, Switzerland.
Spedali Civili Brescia, Brescia, Italy.
Invasive Cardiology, Humanitas Clinical and Research Center, IRCCS, and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Normandie Université, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, Rouen, France.
Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
Erasmus University Medical Center, Rotterdam, the Netherlands.
Clinique Pasteur, Toulouse, France.
Herzzentrum Duisburg, Duisburg, Germany.
A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy.
University Hospital Bonn, Bonn, Germany.
Hadassah Medical Center, Jerusalem, Israel.
S. Ambrogio Cardio-Thoracic Center, Milan, Italy.
University Hospital of Padova, Padova, Italy.
IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
St. Thomas' Hospital Campus, London, United Kingdom.
Emory University Hospital, Atlanta, Georgia, USA.
Helsinki University Central Hospital, Helsinki, Finland.
Humanitas Gavazzeni, Bergamo, Italy.
Tel-Aviv Medical Center, Tel-Aviv, Israel.
Carmel Medical Center, Haifa, Israel.
University Heart Center Freiburg, Bad Krozingen, Germany.
McGill University Health Center, Montreal, Quebec, Canada.
Cardiovascular Center, Frankfurt, Germany.
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
University Medical Centre Ljubljana, Ljubljana, Slovenia.
Montefiore Medical Center, New York, New York, USA.
Brighton & Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
The Heart and Vascular Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
THV Department, HYGEIA Hospital, Athens, Greece.
Columbia University Medical Center, New York, New York, USA.

Background

As transcatheter aortic valve (TAV) replacement is increasingly used in patients with longer life expectancy, a sizable proportion will require redo TAV replacement (TAVR). The unique configuration of balloon-expandable TAV (bTAV) vs a self-expanding TAV (sTAV) potentially affects TAV-in-TAV outcome.

Objectives

The purpose of this study was to better inform prosthesis selection, TAV-in-TAV outcomes were assessed according to the type of initial and subsequent TAV.

Methods

Patients from the Redo-TAVR registry were analyzed using propensity weighting according to their initial valve type (bTAV [n = 115] vs sTAV [n = 106]) and subsequent valve type (bTAV [n = 130] vs sTAV [n = 91]).

Results

Patients with failed bTAVs presented later (vs sTAV) (4.9 ± 2.1 years vs 3.7 ± 2.3 years; P < 0.001), with smaller effective orifice area (1.0 ± 0.7 cm² vs 1.3 ± 0.8 cm²; P = 0.018) and less frequent dominant regurgitation (16.2% vs 47.3%; P < 0.001). Mortality at 30 days was 2.3% (TAV-in-bTAV) vs 0% (TAV-in-sTAV) (P = 0.499) and 1.7% (bTAV-in-TAV) vs 1.0% (sTAV-in-TAV) (P = 0.612); procedural safety was 72.6% (TAV-in-bTAV) vs 71.2% (TAV-in-sTAV) (P = 0.817) and 73.2% (bTAV-in-TAV) vs 76.5% (sTAV-in-TAV) (P = 0.590). Device success was similar according to initial valve type but higher with subsequent sTAV vs bTAV (77.2% vs 64.3%; P = 0.045), primarily because of lower residual gradients (10.3 mm Hg [8.9-11.7 mm Hg] vs 15.2 mm Hg [13.2-17.1 mm Hg]; P < 0.001). Residual regurgitation (moderate or greater) was similar after bTAV-in-TAV and sTAV-in-TAV (5.7%) and nominally higher after TAV-in-bTAV (9.1%) vs TAV-in-sTAV (4.4%) (P = 0.176).

Conclusions

In selected patients, no association was observed between TAV type and redo TAVR safety or mortality, yet subsequent sTAV was associated with higher device success because of lower redo gradients. These findings are preliminary, and more data are needed to guide valve choice for redo TAVR.

中文翻译：

根据初始和后续瓣膜类型重做经导管主动脉瓣置换术的结果

背景

随着经导管主动脉瓣 (TAV) 置换术越来越多地用于预期寿命较长的患者，相当大的比例将需要重做 TAV 置换术 (TAVR)。球囊扩张 TAV (bTAV) 与自扩张 TAV (sTAV) 的独特配置可能会影响 TAV-in-TAV 结果。

目标

本研究的目的是更好地为假体选择提供信息，根据初始和后续 TAV 的类型评估 TAV-in-TAV 结果。

方法

根据初始瓣膜类型（bTAV [n = 115] vs sTAV [n = 106]）和随后的瓣膜类型（bTAV [n = 130] vs sTAV [n = 91]，使用倾向加权分析来自 Redo-TAVR 登记的患者]）。

结果

bTAV 失败的患者出现较晚（vs sTAV）（4.9 ± 2.1 年 vs 3.7 ± 2.3 年；P < 0.001），有效孔面积更小（1.0 ± 0.7 cm ² vs 1.3 ± 0.8 cm ²；P = 0.018）和更少频繁的显性反流（16.2% vs 47.3%；P < 0.001）。30 天时的死亡率为 2.3%（TAV-in-bTAV）vs 0%（TAV-in-sTAV）（P = 0.499）和 1.7%（bTAV-in-TAV）vs 1.0%（sTAV-in-TAV）（P = 0.612); 程序安全性分别为 72.6% (TAV-in-bTAV) vs 71.2% (TAV-in-sTAV) ( P = 0.817) 和 73.2% (bTAV-in-TAV) vs 76.5% (sTAV-in-TAV) ( P = 0.590)。根据初始瓣膜类型，设备成功率相似，但随后的 sTAV 与 bTAV 的成功率更高（77.2% 与 64.3%；P = 0.045），主要是因为残余梯度较低（10.3 mm Hg [8.9-11.7 mm Hg] vs 15.2 mm Hg [ 13.2-17.1 毫米汞柱]；P < 0.001)。bTAV-in-TAV 和 sTAV-in-TAV (5.7%) 后残余反流（中度或更多）相似，TAV-in-bTAV (9.1%) 与 TAV-in-sTAV (4.4%) 相比名义上更高（P = 0.176）。