Marco Barbanti (Ferrarotto Hospital, University of Catania, Catania, Italy) and others report in Circulation: Cardiovascular Interventions that “redo” transcatheter aortic valve implantation (TAVI)—using TAVI vavles to treat patients with failed TAVI valves—seems to be safe and is associated with favourable acute and midterm clinical outcomes.
According to the authors, studies have shown that a “TAV-in-TAV” procedure can be an effective approach for managing TAVI patients with acute implant failure. They comment: “In light of the favourable haemodynamic and clinical outcomes associated with the TAV-in-TAV procedure in this setting, it has been argued that this strategy can also be applied in the setting of non-acute TAVI failure because of structural valve degeneration and significant paravalvular regurgitation.” As “only a few anecdotal reports have demonstrated the feasibility of this approach”, Barbanti et al aimed to examine the safety and midterm efficacy of redo TAVI to treat postprocedural and late transcatheter valve failure.
They collected data for 50 patients who underwent a redo TAVI procedure more than two weeks after undergoing their index TAVI procedure. Of these patients, half underwent the redo procedure because of moderate-to-severe paravalvular regurgitation and the other half underwent the procedure because of valve degeneration. Barbanti et al report that while the mean interval between the index TAVI and the redo TAVI procedure was 812±750 days overall, the interval was significantly lower for patients with paravalvular regurgitation than for patients with valve degeneration: 435±594 days vs. 1,189±706 days, respectively (p<0.001).
“After redo TAVI, all patients left the hospital alive. During hospitalisation, one patient had a non-disabling stroke and another patient had life-threatening bleeding, whereas new permanent pacemaker implantation was required in three out of 35 patients without a pacemaker before redo TAVI,” Barbanti et al state. They add that at a medium follow-up of 586 days after the redo TAVI procedure, survival was 85.1% and noted that this midterm survival rate was “comparable to recent TAVI series”. Furthermore, the authors comment: “Valve performance was uniformly good after redo TAVI (mean transvalvular gradient post redo TAVI: 12.5±6.1mmHg).”
“This multicentre study is the first showing that redo TAVI to treat procedural and late transcatheter valve failure is safe and associated with favourable clinical outcomes. Despite the presence of two transcatheter prostheses, valve performance was reassuring,” Barbanti et al conclude.
Barbanti told Cardiovascular News: “Long-term data on durability are warranted. Also we need to better understand the optimal treatment strategy for re-do TAVI in terms of valve type and size.”