Redo transcatheter aortic valve implantation: Rouen initial experience

Background Transcatheter aortic valve implantation (TAVI) is an established therapy for patients with severe symptomatic aortic valve stenosis at surgical risk. TAVI in dysfunctional transcatheter heart valves (redo TAVI) has been sporadically described and data are limited to clinical cases with short follow-up. Purpose The aim of this study was to evaluate the incidence, the immediate and mid-term results of redo-TAVI in our institution. Methods All patients who underwent TAVI from 2002 to 2020 were included in a prospective database. Clinical and echocardiographic follow-up were performed at one-month and annually on site. Results Among our cohort of 1824 patients, 4 (0.2%) patients (mean age 84 ± 7.4 years) had a redo TAVI, for severe symptomatic structural valve deterioration (SVD) of a balloon expandable transcatheter prosthesis. The predominant mode of SVD was stenosis (75%). The median duration of re-intervention was 6 years after the initial TAVI. Two patients (50%) were treated with a balloon-expandable valve and 2 (50%) patients with a self-expandable prosthesis. All the procedures were performed successfully via a transfemoral approach without any death and any complication. The median duration of follow-up after redo TAVI was 2 years (min 1.2 years and 4.2 years). Mean aortic gradient decreased from 41.2 ± 7.0 at baseline to 19.8 ± 8.1 mmHg (P = 0.03) at 1-month follow-up and only one patient had a gradient > 20 mmHg after redo-TAVI. Mean aortic gradient remained stable at follow-up. There was no rehospitalization for heart failure and one patient died 4.2 years after redo TAVI from a non-cardiac cause. Conclusions Redo-TAVI is rarely necessary and appears to be feasible for dysfunctional transcatheter heart valves. Redo-TAVI is associated with excellent procedural outcomes and acceptable hemodynamic results in the medium term. Further studies are needed in larger population including younger subjects with a longer life expectancy.