Valvular & structural heart diseaseCohort study

Outcomes of repeat transcatheter aortic valve replacement with balloon-expandable valves: a registry study

LancetPublished

  • Registry study
  • propensity-score matched
  • national registry

Authors' conclusion

Redo-TAVR with balloon-expandable valves effectively treated dysfunction of the index TAVR procedure with low procedural complication rates, and death and stroke rates similar to those in patients with a similar clinical profile and predicted risk undergoing TAVR for native aortic valve stenosis.

Study context

Population
Consecutive patients in the STS/ACC Transcatheter Valve Therapy Registry undergoing transcatheter aortic valve replacement (TAVR) with balloon-expandable valves, Nov 2011–Dec 2022
Participants
350,591 patients · 1,320 matched pairs
Exposure
Redo-TAVR vs native-TAVR with balloon-expandable valves
  • Redo-TAVRn = 1,320
  • Native-TAVRn = 349,271reference

Main finding

As reported in the abstract

Death and stroke · 30 days and 1 year

Death at 30 days

P = 0.36

Death at 1 year

P = 0.57

Stroke at 30 days

P = 0.84

Stroke at 1 year

P = 0.80

Observational data: associations, not effects.

Further findings

Aortic valve gradient · 1 year

P < 0.0001

Moderate or severe aortic regurgitation · 1 year

P = 0.18

Death or stroke after redo-TAVR by timing (before/after 1 year of index TAVR) or index valve type

Not significantly affected by timing of redo-TAVR or index transcatheter valve type

Safety

Procedural complications of redo-TAVR
four [0.3%] of 1320 · Coronary compression or obstruction · Intraprocedural death eight [0.6%] of 1320 · Conversion to open heart surgery six [0.5%] of 1319

Procedural complications of redo-TAVR

Low and similar to native-TAVR

Original publication

Outcomes of repeat transcatheter aortic valve replacement with balloon-expandable valves: a registry study. Lancet. Published 31 August 2023. doi:10.1016/s0140-6736(23)01636-7

Summarised from the published abstract; every number is checked against it