Repeat transcatheter aortic valve replacement (TAVR) is associated with better 30-day outcomes than surgical explantation after TAVR, according to new findings published in JACC: Cardiovascular Interventions.
“With the approval of TAVR in low-risk patients, the procedure is being increasingly performed in younger individuals with longer life expectancy,” wrote lead author Edward D. Percy, MD, of the department of surgery at Brigham and Women’s Hospital in Boston, and colleagues. “As a result, future reintervention on TAVR valves is expected to rise. For valvular reintervention after TAVR, surgical explantation of the TAVR prosthesis and repeat TAVR are the two possible options. At this time, the data on aortic valve reintervention after TAVR are scarce, mainly because the early patients were mostly high and extreme risk, and few early TAVR patients have survived to require reintervention.”
To gain a better understanding of post-TAVR aortic valve reintervention, Percy et al. tracked data from more than 133,000 patients in the United States who underwent TAVR from 2012 to 2017. Overall, 617 patients (0.46%) subsequently underwent repeat TAVR. The 30-day mortality rate of repeat TAVR was 6% and the one-year mortality rate was 22%.
When the authors performed a matched analysis that compared 257 repeat TAVR patients with 130 TAVR explantation patients, repeat TAVR had a lower 30-day mortality (6.2% vs. 12.3%) and a one-year mortality that was nearly identical (21% vs 20.8%).
The authors also found that 30-day mortality was lower in patients who underwent TAVR from 2015 to 2017 (4.6%) than those who underwent TAVR from 2012 to 2014 (8.7%).
“One-third of our patients underwent their first TAVR prior to 2015,” the authors wrote. “The TAVRs performed in this era represent a high-risk subgroup, which is reflected in the higher 30-day mortality.”
Percy et al. did note that additional research is needed to evaluate long-term outcomes associated with repeat TAVR. Even with that in mind, however, they highlighted the importance of these findings.
“As TAVR is increasingly applied in younger individuals, providers and patients should consider the risks and benefits of these repeat interventions at the time of initial valve replacement,” the authors wrote. “Our findings provide the first step to the necessary information in this shared decision-making process, as repeat TAVR becomes an increasingly relevant tool in the lifetime management of aortic valve disease.”
The full study is available here.
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.