1Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland; 2Herzzentrum Leipzig - Universität Leipzig Kardiologie Leipzig, Deutschland; 3Herzzentrum Leipzig - Universität Leipzig Universitätsklinik für Herzchirurgie Leipzig, Deutschland
Background: Durability of biological transcatheter heart valves (THV) is limited. As surgical explanation of THVs is associated with increased peri-operative mortality, redo-transcatheter aortic valve implantation (TAVI) remains a desirable treatment option, especially in high-risk elderly patients. However, redo-TAVI is still rarely performed and data describing the mode of THV degeneration and its impact on outcomes after redo-TAVI remain limited.
Methods: In a single high-volume institution performing TAVI since 2006 with an overall volume exceeding 10,000 procedures, 54 patients (0.51%) were treated with redo-TAVI between 2010 and 2023 due to symptomatic severe dysfunction of their index THV. Prespecified endpoints defined according to the VARC-3 recommendations were used to describe technical success, device success and early safety endpoints. Clinical and echocardiographic outcomes were reported up to three years.
Results: Patients presented for redo-TAVI had a mean age of 81.6 ± 5.8 years and an STS risk score of 7.1 [4.9;10.4]. Median time to THV dysfunction was 47.5 months. The mechanism of failure was structural valve deterioration (SVD) in 70.4%, which was more common in intra-annular valves (p<0.001), and non-SVD in 29.6%, which was more common in supra-annular valves (p<0.001). Technical success of redo-TAVI was 92.6% and device success was achieved in 72.2%, which was mainly affected by a residual gradient of ≥20 mmHg in 16.7%. Freedom from VARC-3 defined early safety endpoints was 68.52%. Echocardiographic outcomes significantly improved (<0.001), which persisted in the three-year follow-up-cohort. One-year survival was 86.4%.
Conclusions: Redo-TAVI is a safe and feasible treatment option for selected patients presenting with dysfunctional THVs at high surgical risk with favorable results up to three years. In this cohort, SVD as an indication for redo-TAVI was more common with intra-annular as compared to supra-annular valves.