A second transcatheter procedure may safely and effectively treat patients with degenerated bioprostheses following transcatheter aortic valve replacement (TAVR), according to findings presented at Transcatheter Cardiovascular Therapeutics (TCT) 2020.
TAVR is instrumental in the treatment of patients with severe aortic stenosis, but the durability of bioprostheses and the management of degenerated transcatheter aortic valves (TAV) are still matters of concern for this patient population.
The TRANSIT project aimed to measure procedural and clinical outcomes of a second TAVR procedure for patients facing TAV degeneration by creating an international registry of patients with failed TAV and indication to further TAVR. Data was included from 28 health centers globally. The primary endpoint was overall mortality and cardiovascular mortality at one year.
Out of 40,000 patients treated with TAVR, 172 underwent a second valve replacement: 33% for a mainly stenotic degenerated TAV, 56% for a mainly regurgitant TAV, and 11% for a combined degeneration.
Overall, the rate of class III/IV heart failure, according to the New York Heart Association (NYHA) Heart Failure Classification Scale, was 73.5% at presentation. A second bioprosthetic was implanted in all patients. Device success rate was 79%, due to residual gradient (14%) or regurgitation (7%). After 1 month, overall mortality rate was 2.9%, while rates of hospitalization and class III/IV heart failure were 3.6% and 7% respectively. At 1 year, overall mortality rate rose to 10%, and rates of new hospitalization and class III/IV heart failure were 7.6% and 5.8%, respectively, without significant difference across the groups.
“The expanding adoption of transcatheter aortic valve replacement to relatively young and/or low risk patients will conceivably result in an increasing number of patients with a degenerated bioprosthesis,” the researchers said during their presentation. “These patients may be safely and successfully treated by means of a second transcatheter procedure.”
Testa L. TRANSIT: Treatment of Failed TAVR with TAVR. Presented at TCT 2020.