Valve-in-valve TAVR leads to good 3-year outcomes

  • Webb JG & al.
  • J Am Coll Cardiol
  • 04/06/2019

  • Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • For patients with degenerated surgical bioprosthetic aortic valves undergoing transcatheter aortic valve replacement (TAVR), early improvements in functional status are maintained at the 3-year mark, and left ventricular performance is improved.
  • Mortality compared well with that of high-risk patients undergoing valve replacement for native aortic stenosis in PARTNER cohort A (TAVR, 44.2%; surgery, 44.8%).

Why this matters

  • Despite early postprocedural improvements, little is known about outcomes beyond 1 year after this procedure.

Key results

  • At 3 years: 
    • Mortality, 32.7%; cardiac mortality, 20.5%; stroke, 6.2%; repeat aortic valve replacement, 1.9%.
    • On echocardiogram, no significant difference between 30-day and 3-year measurements of mean effective orifice area or mean gradient. 
    • Total regurgitation: less than mild in 97.5%, moderate in 2.5%, severe in none.
    • New York Heart Association functional class III or IV: 10.4% of patients at 30 days and 14.1% at 3 years, vs 90.4% at baseline.
    • Left ventricular indices improved significantly.

Study design

  • Prospective multicenter PARTNER 2’s nested valve-in-valve and continued-access registries (n=365). 
  • Participants had symptomatic degeneration of surgical aortic bioprostheses, were deemed at high risk (≥50% major morbidity or mortality) for reoperative surgery, and underwent valve-in-valve procedures.
  • Outcomes included 3-year mortality, repeat valve replacement. 
  • Funding: Edwards Lifesciences.

Limitations

  • No randomized comparator arm; nonblinded.