Redo TAVR: Supra-annular, intra-annular valves linked to comparable outcomes
Redo transcatheter aortic valve replacement (TAVR) procedures are generally associated with positive one-year outcomes, according to new findings published in the Journal of the American Heart Association.[1] This appears to be true whether the TAVR devices involved are supra-annular valves, intra-annular valves or a combination of the two.
For this analysis, researchers explored data from 172 patients who underwent redo TAVR—which is also known as TAVR-in-TAVR—from 2011 to 2024. All data came from the PANDORA international registry.
The median time from index TAVR to redo TAVR was 1,401 days. The most common reasons for redo TAVR were structural valve deterioration (SVD), which occurred in 77.9% of cases, and non-SVD valve dysfunction, which occurred in 40.7% of cases. Severe paravalvular leak was the primary cause of non-SVD valve dysfunction.
The two most commonly implanted index valves were supra-annular Corevalve/Evolut devices from Medtronic and intra-annular Sapien devices from Edwards Lifesciences. In both cases, these valves were associated with longer time to degeneration than valves manufactured by other medtech companies. Medtronic and Edwards Lifesciences valves were also the two most commonly implanted second TAVR valves—just 4% of second TAVR valves were made by a manufacturer other than those two companies.
Patients were grouped into four categories based on the configuration of their initial TAVR valve and their second TAVR valve:
- SAV-IAV: A new supra-annular valve implanted into an older intra-annular valve (32 patients)
- SAV-SAV: A new supra-annular valve implanted into an older supra-annular valve (29 patients)
- IAV-SAV: A new intra-annular valve implanted into an older supra-annular valve (74 patients)
- IAV-IAV: A new intra-annular valve implanted into an older intra-annular valve (37 patients)
Overall, no significant differences were seen in these four groups in terms of all-cause mortality or heart failure after one year. IAV-IAV patients were associated with the lowest one-year survival rate, 76.1%, but the difference was not statistically significant.
IAV-IAV patients were also linked to the worst hemodynamic performance in terms of residual transvalvular gradient.
In addition, researchers found that men and chronic kidney disease were both independently associated with an increased risk of death after one year. Single antiplatelet therapy (SAPT), meanwhile, was associated with an increased likelihood of survival.
“The benefit of SAPT aligns with growing data, suggesting a role in reducing bleeding complications after TAVR without increasing thrombotic risk,” wrote first author Antonio Popolo Rubbio, MD, a cardiologist with IRCCS Policlinico San Donato in Italy, and colleagues. “However, the strong protective association observed with SAPT in our analysis should be interpreted with caution. It is conceivable that this finding may partly reflect patient selection rather than a direct causal effect of antiplatelet strategy.”
Rubbio et al. concluded their study by calling for additional research into this topic. They also emphasized the importance of reviewing each individual case before making any treatment decisions.
“Thorough procedural planning is of paramount importance to maximize the risk–benefit profile in this complex scenario,” they wrote.
Click here to read the full analysis.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.