Five-Year Follow-Up from the CoreValve Expanded Use Transcatheter Aortic Valve-in-Surgical Aortic Valve Study

Tanvir K. Bajwa, Roger J. Laham, Kamal Khabbaz, Harold L. Dauerman, Ron Waksman, Eric Weiss, Suhail Allaqaband, Salem Badr, Michael Caskey, Timothy Byrne, Robert J. Applegate, Neal D. Kon, Shuzhen Li, Neal Kleiman, Michael J. Reardon, Stanley J. Chetcuti, G. Michael Deeb

Research output: Contribution to journalArticlepeer-review

Abstract

Transcatheter aortic valve replacement (TAVR) provides an option for extreme-risk patients who underwent reoperation for a failed surgical aortic bioprosthesis. Long-term data on patients who underwent TAVR within a failed surgical aortic valve (TAV-in-SAV) are limited. The CoreValve Expanded Use Study evaluated patients at extreme surgical risk who underwent TAV-in-SAV. Outcomes at 5 years were analyzed by SAV failure mode (stenosis, regurgitation, or combined). Echocardiographic outcomes are site-reported. TAV-in-SAV was attempted in 226 patients with a mean age of 76.7 ± 10.8 years; 63.3% were male, the Society of Thoracic Surgeons predicted risk of mortality score was 9.0 ± 6.7%, and 87.5% had a New York Heart Association classification III or IV symptoms. Most of the failed surgical bioprostheses were stented (81.9%), with an average implant duration of 10.2 ± 4.3 years. The 5-year all-cause mortality or major stroke rate was 47.2% in all patients; 54.4% in the stenosis, 37.6% in the regurgitation, and 38.0% in the combined groups (p = 0.046). At 5 years, all-cause mortality was higher in patients with versus without 30-day severe prosthesis-patient mismatch (51.7% vs 38.3%, p = 0.026). The overall aortic valve reintervention rate was 5.9%; highest in the regurgitation group (12.6%). The mean aortic valve gradient was 14.1 ± 9.8 mm Hg and effective orifice area was 1.57 ± 0.70 at 5 years. Few patients had >mild paravalvular regurgitation at 5 years (5.5% moderate, 0.0% severe). TAV-in-SAV with supra-annular, self-expanding TAVR continues to represent a safe and lasting intermediate option for extreme-risk patients who have appropriate sizing of the preexisting failed surgical valve. Clinical and hemodynamic outcomes were stable through 5 years.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalAmerican Journal of Cardiology
Volume214
DOIs
StatePublished - Mar 1 2024

Keywords

  • outcomes
  • surgical aortic valve failure
  • transcatheter aortic valve replacement
  • Constriction, Pathologic/etiology
  • Follow-Up Studies
  • Humans
  • Heart Valve Prosthesis
  • Risk Factors
  • Aortic Valve Stenosis/diagnosis
  • Male
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement/adverse effects
  • Bioprosthesis
  • Surgical Instruments
  • Prosthesis Design
  • Aged, 80 and over
  • Female
  • Aged
  • Aortic Valve/diagnostic imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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