Aortic valve reintervention after transcatheter aortic valve replacement

被引:9
|
作者
Fukuhara, Shinichi [1 ,2 ]
Nguyen, Chan Tran N. [1 ]
Kim, Karen M. [1 ]
Yang, Bo [1 ]
Ailawadi, Gorav [1 ]
Patel, Himanshu J. [1 ]
Deeb, G. Michael [1 ]
机构
[1] Univ Michigan, Dept Cardiac Surg, Ann Arbor, MI USA
[2] 1500 E Med Ctr Dr, Ann Arbor, MI 48109 USA
来源
关键词
transcatheter aortic valve replacement; surgical transcatheter valve explantation; repeat transcatheter aortic valve replacement; aortic repair; aortic valve disease; RISK; OUTCOMES;
D O I
10.1016/j.jtcvs.2021.03.130
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Despite the rapid adoption of transcatheter aortic valve replacement (TAVR), there are scant data regarding aortic valve reintervention after initial TAVR.Methods: Between 2011 and 2019, 1487 patients underwent a TAVR at the Univer-sity of Michigan. Among these, 24 (1.6%) patients required an aortic valve reinter-vention. Additionally, 4 patients who received a TAVR at another institution underwent a valve reintervention at our institution. We retrospectively reviewed these 28 patients.Results: The median age was 72 years, 36% were female and 86% of implanted TAVR devices were self-expandable. The leading indications for reintervention were structural valve degeneration (39%) and paravalvular leak (36%). The cumu-lative incidence of aortic valve reintervention was 4.6% at 8 years. Most (71%) were deemed unsuitable for repeat TAVR because of the need for concurrent cardiac procedures (50%), unfavorable anatomy (45%), or endocarditis (10%). TAVR valve explant was associated with frequent concurrent procedures, consisting of aortic repair (35%), mitral repair/replacement (35%), tricuspid repair (25%), and coronary artery bypass graft (20%). Seventy-one percent of aortic procedures were unplanned but proved necessary because of severe adhesion of the devices to the contacting tissue. There were 3 (15%) in-hospital mortalities in the TAVR valve explant group, whereas there was no mortality in the repeat TAVR group.Conclusions: Repeat TAVR procedure was frequently not feasible because of un-favorable anatomy and/or the need for concurrent cardiac procedures. Careful assessment of TAVR procedure repeatability should be weighed at the initial TAVR workup especially in younger patients who are expected to require a valve reintervention. (J Thorac Cardiovasc Surg 2023;165:1321-32)
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页数:16
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