Transcatheter Aortic Valve Replacement With Self-Expandable Supra-Annular Valves for Degenerated Surgical Bioprostheses: Insights From Transcatheter Valve Therapy Registry

• Type of Material: Article
• Authors: Luis Augusto P Dallan, University Hospitals of Cleveland; John K Forrest, Yale University; Michael J Reardon, Houston Methodist; Wilson Y Szeto, University of Pennsylvania; Isaac George, Columbia Univ New York Presbyterian; Susheel Kodali, Columbia Univ New York Presbyterian; Neal S Kleiman, Houston Methodist; Steven J Yakubov, Riverside Methodist Hosp; Kendra Grubb, Emory University; Fang Liu, Emory University; Cristian Baeza, University Hospitals of Cleveland; Guilherme F Attizzani, University Hospitals of Cleveland
• Language: English
• Date: 2021-09-21
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.121.021871
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: 10
• Issue: 18
• Start Page: e021871
• End Page: e021871
• Grant/Funding Information: This work was supported by Medtronic (Minneapolis, Minnesota).
• Keywords: LONG-TERM OUTCOMES; 1-YEAR OUTCOMES; transcatheter aortic valve replacement; CHOICE; Science & Technology; SOCIETY; PREDICTORS; surgical aortic valve replacement; THORACIC SURGEONS/AMERICAN COLLEGE; valve-in-valve; Cardiovascular System & Cardiology; PERMANENT PACEMAKER IMPLANTATION; CLINICAL-OUTCOMES; Life Sciences & Biomedicine; END-POINT DEFINITIONS; transcatheter aortic valve replacement in degenerated surgical aortic valve; Cardiac & Cardiovascular Systems; RISK
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

BACKGROUND: Transcatheter aortic valve replacement with supra-annular transcatheter heart valves has been adopted in patients with degenerated surgical aortic valves. The next generation self-expanding Evolut PRO valve has not been evaluated in patients with surgical valve failure. METHODS AND RESULTS: Patients undergoing transcatheter aortic valve replacement in degenerated surgical aortic valve procedures using the Evolut R or Evolut PRO transcatheter heart valves in the Society of Thoracic Surgeons and American College of Cardiology Transcatheter Valve Therapy Registry between April 2015 and June 2019 were evaluated. Transcatheter valve performance was evaluated by clinical site echocardiography. In-hospital, 30-day, and 1-year clinical outcomes were based on the Society of Thoracic Surgeons-American College of Cardiology-Transcatheter Valve Therapy registry definitions. Transcatheter aortic valve replacement in degenerated surgical aortic valve was performed in 5897 patients (5061 [85.8%] patients received the Evolut R valve and 836 [14.2%] received the Evolut PRO valve). Thirty-day transcatheter heart valves hemodynamic performance was excellent in both groups (mean gradient: Evolut PRO: 13.8±7.5 mm Hg; Evolut R: 14.5±8.1 mm Hg), while paravalvular regurgitation was significantly different between valve types (P=0.02). Clinical events were low at 30 days (Evolut PRO: for the all-cause mortality, 2.8%, any stroke was 1.8%, new pacemaker implantation, 3.0%: Evolut R:all-cause mortality, 2.5%, any stroke was 2.2%, new pacemaker implantation, 5.3%) and 1 year (Evolut PRO: all-cause mortality, 9.2%; any stroke, 3.1%; Evolut R: all-cause mortality, 9.8%; any stroke, 2.9%). CONCLUSIONS: Transcatheter aortic valve replacement in degenerated surgical aortic valve with self-expandable supra-annular transcatheter heart valves is associated with excellent clinical outcomes and valve hemodynamics. Additional reductions in residual paravalvular regurgitation were obtained with the next generation Evolut PRO.