TAVR for degenerated prostheses tied to improved survival, functional outcomes at 3 years
Use of transcatheter aortic valve replacement (TAVR) for bioprosthetic aortic valve failure results in favourable survival, sustained improved haemodynamic status, and excellent functional and quality-of-life outcomes at 3 years, a study has shown.
A total of 365 patients (mean age, 78.9±10.2 years; mean Society of Thoracic Surgeons score, 9.1±4.7 percent) underwent valve-in-valve procedures. The overall Kaplan-Meier estimate of all-cause mortality at 3-year follow-up was 32.7 percent. Of the patients, 1.9 percent required aortic valve re-replacement.
Mean transaortic gradient decreased from 35.0 mm Hg at baseline to 17.8 mm Hg at 30-day follow-up and 16.6 mm Hg at 3-year follow-up. Baseline effective orifice area increased from 0.93 cm2 to 1.13 cm2 at 30 days and 1.15 cm2 at 3 years.
A decrease was observed in moderate-to-severe aortic regurgitation from 45.1 percent at pre-TAVR baseline to 2.5 percent at 3 years. There was also a significant reduction in moderate or severe mitral (33.7 percent vs 98.6 percent; p<0.0001) and tricuspid regurgitation (29.7 percent vs 18.8 percent; p=0.002).
Left ventricular ejection fraction increased from 50.7 percent at baseline to 54.7 percent at 3 years (p<0.0001), while left ventricular mass decreased from 136.4 g/m2 at baseline to 109.1 g/m2 at 3 years (p<0.0001).
Moreover, New York Heart Association functional class improved from 90.4 percent in class III/IV at baseline to 14.1 percent at 3 years (p<0.0001), while Kansan City Cardiomyopathy Questionnaire overall score increased from 43.1 to 73.1 (p<0.0001).
To examine late outcomes after valve-in-valve TAVR, the investigators prospectively enrolled patients with symptomatic degeneration of surgical aortic bioprostheses at high risk (≥50-percent major morbidity or mortality) for reoperative surgery in the multicenter PARTNER (Placement of Aortic Transcatheter Valves) 2 valve-in-valve and continued access registries. They also obtained 3-year clinical and echocardiographic follow-up.