Redo transcatheter aortic valve replacement (TAVR) with balloon-expandable valves is safe and associated with positive outcomes, according to new research published in The Lancet.[1]
The study represents a collaboration of some of the most established hospitals and academic institutions in the United States, including Cedars-Sinai, Cleveland Clinic, Columbia University, Mount Sinai Heart and Baylor Scott and White Health.
Hoping to learn more about the available treatment options when transcatheter aortic valves fail, researchers examined data from more than 350,000 consecutive patients who underwent TAVR from November 2011 to December 2022. Each patient was treated with a balloon-expandable valve. All data came from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.
Overall, the authors noted, 1,320 patients required a redo TAVR procedure. The mean age of that group was 78 years old. Redo TAVR patients were matched with 1,320 patients with similar characteristics who underwent a standard, first-time TAVR procedure as opposed to redo TAVR.
The number of procedural complications was comparable between the redo TAVR group and the first-time TAVR group. In addition, there were no significant differences in terms of 30-day mortality, one-year mortality, 30-day stroke rates or one-year stroke rates. Moderate and severe aortic regurgitation rates were also similar after one year.
The authors confirmed that the timing of redo TAVR—within one year of the initial procedure or later than one year—did not seem to make a significant impact on mortality or the risk of stroke.
“We now know that redo TAVR with balloon-expandable valves may be a reasonable treatment for failed TAVR procedures in select patients,” senior author Raj Makkar, MD, a veteran interventional cardiologist and vice president of Cardiovascular Innovation and Intervention at Cedars-Sinai, said in a prepared statement. “This is increasingly important, as the patients treated with TAVR are younger than they were a decade ago, meaning they will likely need a repeat procedure at some point in their lifetime.”
“Our finding that TAVR can be redone safely is yet another step in establishing this as the default technology for aortic valve disease,” added Eduardo Marbán, MD, PhD, executive director of the Smidt Heart Institute at Cedars-Sinai, in the same statement.
Co-authors included Martin B. Leon, MD, with the Columbia University Department of Medicine; Samir Kapadia, MD, with Cleveland Clinic; Deepak L. Bhatt, MD, with Mount Sinai Heart; Michael Mack, MD, with Baylor Scott and White; and other leading names in the field of cardiology.
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.