Does valve in valve TAVR carry a higher risk for thromboembolic events compared to native valve TAVR?. Issue 5 (9th July 2019) - Eitan, Amnon
Abstract: Objective: To evaluate the risk for brain lesions in valve in valve (VIV)‐transcatheter aortic valve replacement (TAVR) compared to native valve procedures (NV‐TAVR). Background: TAVR is associated with the risk of stroke and a high incidence of brain lesions in diffusion‐weighted magnetic resonance imaging (DW‐MRI). The risk in VIV procedures is unknown. Methods: Patients were included, if they received a Sapien‐3 or an Evolut‐R valve for an NV‐TAVR or VIV‐TAVR and a DW‐MRI within 3–5 days after the procedure. Results: Two hundred nine patients had NV‐TAVR and 41 patients had VIV‐TAVR. The VIV group was significantly younger (mean 82.3 vs. 74.7 years old, p < .001) but had higher mean EuroSCORE II (4.8 vs. 7.8, p < .001). Predilatation was significantly more common with native valve (39% vs. 2%, p < .01), postdilatation rate was lower in VIV but without statistical significance (17% vs. 7%, p = .110). Combined in‐hospital safety outcome was comparable [13(6.6%) vs. 5(12.2%), p = .205]. Any stroke was documented in four (0.5%) patients after native valve and in one (2.4%) after VIV‐TAVR. New DW‐MRI brain lesions were significantly more often found in patients with native valves [153(73.2%) vs. 21(51.2%), p = .005], mean number of new lesions was also higher with native valve (2.8 ± 3.2 vs. 1.0 ± 1.4, p < .001). Forward stepwise of logistic regression found age and post dilatation significant predictors of new MRI lesions. Conclusions: Compared to native valves, VIV procedures were associated with lower incidence and number of brain lesions according to DW‐MRI; these were explained by lower patients' age and lower rate of postdilatation.