Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation: prognostic implications

Uri Landes*, Aviram Hochstadt, Lisa Manevich, John G. Webb, Janarthanan Sathananthan, Horst Sievert, Kerstin Piayda, Martin B. Leon, Tamim M. Nazif, David Blusztein, David Hildick-Smith, Chris Pavitt, Holger Thiele, Mohamed Abdel-Wahab, Nicolas M. Van Mieghem, Rik Adrichem, Lars Sondergaard, Ole De Backer, Raj R. Makkar, Ofir KorenThomas Pilgrim, Taishi Okuno, Ran Kornowski, Pablo Codner, Ariel Finkelstein, Itamar Loewenstein, Israel Barbash, Amir Sharon, Federico De Marco, Matteo Montorfano, Nicola Buzzatti, Azeem Latib, Andrea Scotti, Won Keun Kim, Christian Hamm, Luis Nombela Franco, Antonio Mangieri, Wolfgang H. Schoels, Marco Barbanti, Matjaz Bunc, Myriama Akodad, Ronen Rubinshtein, Haim Danenberg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Aims Paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) is associated with increased morbidity and mortality. The effect of transcatheter interventions to treat PVR after the index TAVI was investigated. Methods A registry of consecutive patients who underwent transcatheter intervention for ≥ moderate PVR after the index TAVI at 22 and results centers. The principal outcomes were residual aortic regurgitation (AR) and mortality at 1 year after PVR treatment. A total of 201 patients were identified: 87 (43%) underwent redo-TAVI, 79 (39%) plug closure, and 35 (18%) balloon valvuloplasty. Median TAVI-to-re-intervention time was 207 (35; 765) days. The failed valve was self-expanding in 129 (63.9%) patients. The most frequent devices utilized were a Sapien 3 valve for redo-TAVI (55, 64%), an AVP II as plug (33, 42%), and a True balloon for valvuloplasty (20, 56%). At 30 days, AR ≥ moderate persisted in 33 (17.4%) patients: 8 (9.9%) after redo-TAVI, 18 (25.9%) after plug, and 7 (21.9%) after valvuloplasty (P = 0.036). Overall mortality was 10 (5.0%) at 30 days and 29 (14.4%) at 1 year: 0, 8 (10.1%), and 2 (5.7%) at 30 days (P = 0.010) and 11 (12.6%), 14 (17.7%), and 4 (11.4%) at 1 year (P = 0.418), after redo-TAVI, plug, and valvuloplasty, respectively. Regardless of treatment strategy, patients in whom AR was reduced to ≤ mild had lower mortality at 1 year compared with those with AR persisting ≥ moderate [11 (8.0%) vs. 6 (21.4%); P = 0.007]. Conclusion This study describes the efficacy of transcatheter treatments for PVR after TAVI. Patients in whom PVR was successfully reduced had better prognosis. The selection of patients and the optimal PVR treatment modality require further investigation.

Original languageEnglish
Pages (from-to)1331-1339
Number of pages9
JournalEuropean Heart Journal
Volume44
Issue number15
DOIs
StatePublished - 14 Apr 2023

Keywords

  • Paravalvular regurgitation (PVR)
  • Plug
  • Redo-TAVI
  • TAVI
  • Valvuloplasty

Fingerprint

Dive into the research topics of 'Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation: prognostic implications'. Together they form a unique fingerprint.

Cite this