Transcatheter Aortic Valve Replacement for Degenerated Transcatheter Aortic Valves: The TRANSIT International Project
Testa, Luca; Agnifili, Mauro; Van Mieghem, Nicolas M; Tchétché, Didier; Asgar, Anita W; De Backer, Ole; Latib, Azeem; Reimers, Bernhard; Stefanini, Giulio; Trani, Carlo; Colombo, Antonio; Giannini, Francesco; Bartorelli, Antonio; Wojakowski, Wojtek; Dabrowski, Maciej; Jagielak, Dariusz; Banning, Adrian P; Kharbanda, Rajesh; Moreno, Raul; Schofer, Joachim; van Royen, Niels; Pinto, Duane; Serra, Antoni; Segev, Amit; Giordano, Arturo; Brambilla, Nedy; Popolo Rubbio, Antonio; Casenghi, Matteo; Oreglia, Jacopo; De Marco, Federico; Tanja, Rudolph; McCabe, James M; Abizaid, Alexander; Voskuil, Michiel; Teles, Rui; Biondi Zoccai, Giuseppe; Bianchi, Giovanni; Sondergaard, Lars; Bedogni, Francesco
(2021) Circulation. Cardiovascular Interventions, volume 14, issue 6, pp. 628 - 638
(Article)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has determined a paradigm shift in the treatment of patients with severe aortic stenosis. However, the durability of bioprostheses is still a matter of concern, and little is known about the management of degenerated TAV. We sought to evaluate the outcomes of patients with
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a degenerated TAV treated by means of a second TAVR. Methods: The TRANSIT is an international registry that included cases of degenerated TAVR from 28 centers. Among around 40 000 patients treated with TAVR in the participating centers, 172 underwent a second TAVR: 57 (33%) for a mainly stenotic degenerated TAV, 97 (56%) for a mainly regurgitant TAV, and 18 (11%) for a combined degeneration. Overall, the rate of New York Heart Association class III/IV at presentation was 73.5%. Results: Valve Academic Research Consortium 2 device success rate was 79%, as a consequence of residual gradient (14%) or regurgitation (7%). At 1 month, the overall mortality rate was 2.9%, while rates of new hospitalization and New York Heart Association class III/IV were 3.6% and 7%, respectively, without significant difference across the groups. At 1 year, the overall mortality rate was 10%, while rates of new hospitalization and New York Heart Association class III/IV were 7.6% and 5.8%, respectively, without significant difference across the groups. No cases of valve thrombosis were recorded. Conclusions: Selected patients with a degenerated TAV may be safely and successfully treated by means of a second TAVR. This finding is of crucial importance for the adoption of the TAVR technology in a lower risk and younger population. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04500964.
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Keywords: bioprosthesis, heart failure, transcatheter aortic valve replacement, Cardiology and Cardiovascular Medicine, Journal Article
ISSN: 1941-7640
Publisher: Lippincott Williams and Wilkins
Note: Publisher Copyright: © 2021 Lippincott Williams and Wilkins. All rights reserved.
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