TAVR reinterventions: What new data tell us about redo, explant trends over time
Transcatheter aortic valve replacement (TAVR) reintervention rates remain low, according to new data published in JAMA Cardiology.[1] However, they are slowly rising as the procedure to gains more momentum as the primary treatment option for patients with severe aortic stenosis.
The study’s authors wanted to evaluate reintervention rates due to the rising number of patients undergoing TAVR who may have been a better candidate for surgical aortic valve replacement (SAVR).
“After the results of randomized clinical trials of low-risk patients in 2019, TAVR became an option for patients of all surgical risk levels,” wrote first author Maxwell C. Braasch, MD, a resident with the department of surgery at Washington University in St. Louis, and colleagues. “Although the American College of Cardiology/American Heart Association guidelines suggest that young, non–high-risk patients younger than 65 years should undergo SAVR, nearly 50% of younger patients in the United States receive TAVRs. However, it is important to consider that younger age does not always correlate with lower procedural risk. Since all bioprosthetic valves will develop structural valve degeneration, we anticipate a rise in TAVR reintervention, especially in low-risk patients with long life expectancy.”
Braasch et al. reviewed data from more than 410,000 patients who underwent TAVR from January 2012 to June 2024.
Overall, 0.91% of TAVR patients underwent either redo TAVR or TAVR explant, the two TAVR reintervention procedures. While 63.8% of these patients underwent redo TAVR, the remaining 36.2% underwent TAVR explant.
Digging deeper into the data, the team found that 86.8% of redo TAVR patients were diagnosed with congestive heart failure. In addition, 16.1% of TAVR explant patients also underwent concomitant coronary artery bypass grafting (CABG), 25% also underwent concomitant mitral valve surgery and 14.9% also underwent concomitant thoracic aortic valve surgery.
One key takeaway from the group’s findings was that TAVR reinterventions are growing more common as more low-risk patients undergo the procedure. For example, 0.17% of patients underwent TAVR reintervention in 2019 compared to 0.28% in 2023.
Another critical finding was the fact that the most common length of time between TAVR and redo TAVR was three months or less.
“Early reintervention likely represents technical failure of the index TAVR, such as paravalvular regurgitation or patient-prosthesis mismatch,” the authors wrote.
Braasch and colleagues also explored SAVR data over the course of the study. Of the nearly 300,000 patients who underwent SAVR during this time, 1.68% underwent a TAVR after SAVR (valve-in-valve TAVR) and 1.4% patients underwent redo SAVR after an initial SAVR. The annual incidence of SAVR reintervention has increased from 0.24% in 2014 to 0.73% in 2023—but redo SAVR is actually on the decline, meaning that the increase is driven entirely by the increase in valve-in-valve TAVR procedures performed after an initial TAVR.
“It is important to continue monitoring annual TAVR and SAVR reintervention incidence and volume,” the authors wrote. “We expect a continued increase in the TAVR reintervention incidence as we move to more lower risk patients, emphasizing the importance of lifetime management of AS.”
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.