Transcatheter Aortic Valve Replacement for Degenerated Transcatheter Aortic Valves: The TRANSIT International Project. (7th June 2021)

• Record Type: Journal Article
• Authors: 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;
• Is Part Of: Circulation. Volume 14:Number 6(2021)
• Page Start: e010440
• Publication Date: 2021-06-07
• Subjects: bioprosthesis -- heart failure -- transcatheter aortic valve replacement; Cardiovascular system -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Treatment -- Periodicals; 616.105
• DOI: 10.1161/CIRCINTERVENTIONS.120.010440
• Languages: English
• ISSNs: 1941-7640

Abstract

Abstract : Supplemental Digital Content is available in the text. 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 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.