Transcatheter Aortic Valve Replacement for Degenerated Transcatheter Aortic Valves The TRANSIT International Project
Por:
Testa, L, Agnifili, M, Van Mieghem, NM, Tchetche, D, Asgar, AW, De Backer, O, Latib, A, Reimers, B, Stefanini, G, Trani, C, Colombo, A, Giannini, F, Bartorelli, A, Wojakowski, W, Dabrowski, M, Jagielak, D, Banning, AP, Kharbanda, R, Moreno, R, Schofer, J, van Royen, N, Pinto, D, Serra, A, Segev, A, Giordano, A, Brambilla, N, Rubbio, AP, Casenghi, M, Oreglia, J, De Marco, F, Tanja, R, McCabe, JM, Abizaid, A, Voskuil, M, Teles, R, Zoccai, GB, Bianchi, G, Sondergaard, L, Bedogni, F
Publicada:
1 jun 2021
Resumen:
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.
Filiaciones:
Testa, L:
IRCCS Policlin S Donato, Milan, Italy
Agnifili, M:
IRCCS Policlin S Donato, Milan, Italy
Van Mieghem, NM:
Erasmus Univ, Med Ctr, Rotterdam, Netherlands
Tchetche, D:
Clin Pasteur, Grp CardioVasc Intervent, Toulouse, France
Asgar, AW:
Montreal Heart Inst, Montreal, PQ, Canada
De Backer, O:
Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark
Latib, A:
Montefiore Med Ctr, New York, NY USA
Reimers, B:
IRCCS, Humanitas Res Ctr, Rozzano Milan, Italy
Stefanini, G:
IRCCS, Humanitas Res Ctr, Rozzano Milan, Italy
Trani, C:
Policlin Univ A Gemelli, Rome, Italy
Colombo, A:
Maria Cecilia Hosp, Cotignola, Ravenna, Italy
Giannini, F:
Maria Cecilia Hosp, Cotignola, Ravenna, Italy
Bartorelli, A:
IRCCS, Ctr Cardiol Monzino, Milan, Italy
Univ Milan, Dept Biomed & Clin Sci Luigi Sacco, Milan, Italy
Wojakowski, W:
Med Univ Silesia, Katowice, Poland
Dabrowski, M:
Natl Inst Cardiol, Dept Intervent Cardiol & Angiol, Warsaw, Poland
Jagielak, D:
Med Univ, Gdansk, Poland
Banning, AP:
John Radcliffe Hosp, Oxford, England
Kharbanda, R:
John Radcliffe Hosp, Oxford, England
Moreno, R:
Hosp La Paz, IdiPAZ, CIBER CV, Madrid, Spain
Schofer, J:
MVZ Dept Struct Heart Dis St Georg, Hamburg, Germany
van Royen, N:
Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands
Pinto, D:
Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA
Serra, A:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Segev, A:
Chaim Sheba Med Ctr, Heart & Vasc Ctr, Tel Hashomer, Israel
Giordano, A:
Pineta Grande Hosp, Caserta, Italy
Brambilla, N:
IRCCS Policlin S Donato, Milan, Italy
Rubbio, AP:
IRCCS Policlin S Donato, Milan, Italy
Casenghi, M:
IRCCS Policlin S Donato, Milan, Italy
Oreglia, J:
Osped Niguarda Ca Granda, Milan, Italy
De Marco, F:
IRCCS Policlin S Donato, Milan, Italy
Tanja, R:
Heart & Diabet Ctr NRW, Bad Oeynhausen, Germany
McCabe, JM:
Univ Washington, Seattle, WA 98195 USA
Abizaid, A:
Inst Dante Pazzanese Cardiol, Sao Paulo, Brazil
Voskuil, M:
Univ Med Ctr, Utrecht, Netherlands
Teles, R:
Ctr Hosp Lisboa Ocidental, Hosp Santa Cruz, Lisbon, Portugal
Zoccai, GB:
Sapienza Univ Rome, Dept Medicosurg Sci & Biotechnol, Rome, Italy
Bianchi, G:
IRCCS Policlin S Donato, Milan, Italy
Sondergaard, L:
Montreal Heart Inst, Montreal, PQ, Canada
Bedogni, F:
IRCCS Policlin S Donato, Milan, Italy
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