Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation: prognostic implications

Uri Landes; Aviram Hochstadt; Lisa Manevich; John G Webb; Janarthanan Sathananthan; Horst Sievert; Kerstin Piayda; Martin B Leon; Tamim M Nazif; David Blusztein; David Hildick-Smith; Chris Pavitt; Holger Thiele; Mohamed Abdel-Wahab; Nicolas M Van Mieghem; Rik Adrichem; Lars Sondergaard; Ole De Backer; Raj R Makkar; Ofir Koren; Thomas Pilgrim; Taishi Okuno; Ran Kornowski; Pablo Codner; Ariel Finkelstein; Itamar Loewenstein; Israel Barbash; Amir Sharon; Federico De Marco; Matteo Montorfano; Nicola Buzzatti; Azeem Latib; Andrea Scotti; Won-Keun Kim; Christian Hamm; Luis Nombela Franco; Antonio Mangieri; Wolfgang H Schoels; Marco Barbanti; Matjaz Bunc; Myriama Akodad; Ronen Rubinshtein; Haim Danenberg

doi:10.1093/eurheartj/ehad146

Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation: prognostic implications

Uri Landes^*, Aviram Hochstadt, Lisa Manevich, John G Webb, Janarthanan Sathananthan, Horst Sievert, Kerstin Piayda, Martin B Leon, Tamim M Nazif, David Blusztein, David Hildick-Smith, Chris Pavitt, Holger Thiele, Mohamed Abdel-Wahab, Nicolas M Van Mieghem, Rik Adrichem, Lars Sondergaard, Ole De Backer, Raj R Makkar, Ofir KorenThomas Pilgrim, Taishi Okuno, Ran Kornowski, Pablo Codner, Ariel Finkelstein, Itamar Loewenstein, Israel Barbash, Amir Sharon, Federico De Marco, Matteo Montorfano, Nicola Buzzatti, Azeem Latib, Andrea Scotti, Won-Keun Kim, Christian Hamm, Luis Nombela Franco, Antonio Mangieri, Wolfgang H Schoels, Marco Barbanti, Matjaz Bunc, Myriama Akodad, Ronen Rubinshtein, Haim Danenberg

^*Corresponding author for this work

Department of Cardiology

30 Citations (Scopus)

Abstract

AIMS: Paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) is associated with increased morbidity and mortality. The effect of transcatheter interventions to treat PVR after the index TAVI was investigated.

METHODS AND RESULTS: A registry of consecutive patients who underwent transcatheter intervention for ≥ moderate PVR after the index TAVI at 22 centers. The principal outcomes were residual aortic regurgitation (AR) and mortality at 1 year after PVR treatment. A total of 201 patients were identified: 87 (43%) underwent redo-TAVI, 79 (39%) plug closure, and 35 (18%) balloon valvuloplasty. Median TAVI-to-re-intervention time was 207 (35; 765) days. The failed valve was self-expanding in 129 (63.9%) patients. The most frequent devices utilized were a Sapien 3 valve for redo-TAVI (55, 64%), an AVP II as plug (33, 42%), and a True balloon for valvuloplasty (20, 56%). At 30 days, AR ≥ moderate persisted in 33 (17.4%) patients: 8 (9.9%) after redo-TAVI, 18 (25.9%) after plug, and 7 (21.9%) after valvuloplasty (P = 0.036). Overall mortality was 10 (5.0%) at 30 days and 29 (14.4%) at 1 year: 0, 8 (10.1%), and 2 (5.7%) at 30 days (P = 0.010) and 11 (12.6%), 14 (17.7%), and 4 (11.4%) at 1 year (P = 0.418), after redo-TAVI, plug, and valvuloplasty, respectively. Regardless of treatment strategy, patients in whom AR was reduced to ≤ mild had lower mortality at 1 year compared with those with AR persisting ≥ moderate [11 (8.0%) vs. 6 (21.4%); P = 0.007].

CONCLUSION: This study describes the efficacy of transcatheter treatments for PVR after TAVI. Patients in whom PVR was successfully reduced had better prognosis. The selection of patients and the optimal PVR treatment modality require further investigation.

Original language	English
Journal	European Heart Journal
Volume	44
Issue number	15
Pages (from-to)	1331-1339
Number of pages	9
ISSN	0195-668X
DOIs	https://doi.org/10.1093/eurheartj/ehad146
Publication status	Published - 17 Apr 2023

Keywords

Aortic Valve Insufficiency/etiology
Aortic Valve Stenosis
Aortic Valve/diagnostic imaging
Heart Valve Prosthesis
Humans
Prognosis
Transcatheter Aortic Valve Replacement/methods
Treatment Outcome
TAVI
Plug
Paravalvular regurgitation (PVR)
Redo-TAVI
Valvuloplasty

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Landes, U., Hochstadt, A., Manevich, L., Webb, J. G., Sathananthan, J., Sievert, H., Piayda, K., Leon, M. B., Nazif, T. M., Blusztein, D., Hildick-Smith, D., Pavitt, C., Thiele, H., Abdel-Wahab, M., Van Mieghem, N. M., Adrichem, R., Sondergaard, L., De Backer, O., Makkar, R. R., ... Danenberg, H. (2023). Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation: prognostic implications. European Heart Journal, 44(15), 1331-1339. https://doi.org/10.1093/eurheartj/ehad146

Landes, U, Hochstadt, A, Manevich, L, Webb, JG, Sathananthan, J, Sievert, H, Piayda, K, Leon, MB, Nazif, TM, Blusztein, D, Hildick-Smith, D, Pavitt, C, Thiele, H, Abdel-Wahab, M, Van Mieghem, NM, Adrichem, R, Sondergaard, L , De Backer, O, Makkar, RR, Koren, O, Pilgrim, T, Okuno, T, Kornowski, R, Codner, P, Finkelstein, A, Loewenstein, I, Barbash, I, Sharon, A, De Marco, F, Montorfano, M, Buzzatti, N, Latib, A, Scotti, A, Kim, W-K, Hamm, C, Nombela Franco, L, Mangieri, A, Schoels, WH, Barbanti, M, Bunc, M, Akodad, M, Rubinshtein, R & Danenberg, H 2023, 'Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation: prognostic implications', European Heart Journal, vol. 44, no. 15, pp. 1331-1339. https://doi.org/10.1093/eurheartj/ehad146

@article{d62063f3ac0e486793a20e107f2ab8a1,

title = "Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation: prognostic implications",

abstract = "AIMS: Paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) is associated with increased morbidity and mortality. The effect of transcatheter interventions to treat PVR after the index TAVI was investigated.METHODS AND RESULTS: A registry of consecutive patients who underwent transcatheter intervention for ≥ moderate PVR after the index TAVI at 22 centers. The principal outcomes were residual aortic regurgitation (AR) and mortality at 1 year after PVR treatment. A total of 201 patients were identified: 87 (43\%) underwent redo-TAVI, 79 (39\%) plug closure, and 35 (18\%) balloon valvuloplasty. Median TAVI-to-re-intervention time was 207 (35; 765) days. The failed valve was self-expanding in 129 (63.9\%) patients. The most frequent devices utilized were a Sapien 3 valve for redo-TAVI (55, 64\%), an AVP II as plug (33, 42\%), and a True balloon for valvuloplasty (20, 56\%). At 30 days, AR ≥ moderate persisted in 33 (17.4\%) patients: 8 (9.9\%) after redo-TAVI, 18 (25.9\%) after plug, and 7 (21.9\%) after valvuloplasty (P = 0.036). Overall mortality was 10 (5.0\%) at 30 days and 29 (14.4\%) at 1 year: 0, 8 (10.1\%), and 2 (5.7\%) at 30 days (P = 0.010) and 11 (12.6\%), 14 (17.7\%), and 4 (11.4\%) at 1 year (P = 0.418), after redo-TAVI, plug, and valvuloplasty, respectively. Regardless of treatment strategy, patients in whom AR was reduced to ≤ mild had lower mortality at 1 year compared with those with AR persisting ≥ moderate [11 (8.0\%) vs. 6 (21.4\%); P = 0.007].CONCLUSION: This study describes the efficacy of transcatheter treatments for PVR after TAVI. Patients in whom PVR was successfully reduced had better prognosis. The selection of patients and the optimal PVR treatment modality require further investigation.",

keywords = "Aortic Valve Insufficiency/etiology, Aortic Valve Stenosis, Aortic Valve/diagnostic imaging, Heart Valve Prosthesis, Humans, Prognosis, Transcatheter Aortic Valve Replacement/methods, Treatment Outcome, TAVI, Plug, Paravalvular regurgitation (PVR), Redo-TAVI, Valvuloplasty",

author = "Uri Landes and Aviram Hochstadt and Lisa Manevich and Webb, \{John G\} and Janarthanan Sathananthan and Horst Sievert and Kerstin Piayda and Leon, \{Martin B\} and Nazif, \{Tamim M\} and David Blusztein and David Hildick-Smith and Chris Pavitt and Holger Thiele and Mohamed Abdel-Wahab and \{Van Mieghem\}, \{Nicolas M\} and Rik Adrichem and Lars Sondergaard and \{De Backer\}, Ole and Makkar, \{Raj R\} and Ofir Koren and Thomas Pilgrim and Taishi Okuno and Ran Kornowski and Pablo Codner and Ariel Finkelstein and Itamar Loewenstein and Israel Barbash and Amir Sharon and \{De Marco\}, Federico and Matteo Montorfano and Nicola Buzzatti and Azeem Latib and Andrea Scotti and Won-Keun Kim and Christian Hamm and \{Nombela Franco\}, Luis and Antonio Mangieri and Schoels, \{Wolfgang H\} and Marco Barbanti and Matjaz Bunc and Myriama Akodad and Ronen Rubinshtein and Haim Danenberg",

note = "{\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: [email protected].",

year = "2023",

month = apr,

day = "17",

doi = "10.1093/eurheartj/ehad146",

language = "English",

volume = "44",

pages = "1331--1339",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "15",

}

TY - JOUR

T1 - Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation

T2 - prognostic implications

AU - Landes, Uri

AU - Hochstadt, Aviram

AU - Manevich, Lisa

AU - Webb, John G

AU - Sathananthan, Janarthanan

AU - Sievert, Horst

AU - Piayda, Kerstin

AU - Leon, Martin B

AU - Nazif, Tamim M

AU - Blusztein, David

AU - Hildick-Smith, David

AU - Pavitt, Chris

AU - Thiele, Holger

AU - Abdel-Wahab, Mohamed

AU - Van Mieghem, Nicolas M

AU - Adrichem, Rik

AU - Sondergaard, Lars

AU - De Backer, Ole

AU - Makkar, Raj R

AU - Koren, Ofir

AU - Pilgrim, Thomas

AU - Okuno, Taishi

AU - Kornowski, Ran

AU - Codner, Pablo

AU - Finkelstein, Ariel

AU - Loewenstein, Itamar

AU - Barbash, Israel

AU - Sharon, Amir

AU - De Marco, Federico

AU - Montorfano, Matteo

AU - Buzzatti, Nicola

AU - Latib, Azeem

AU - Scotti, Andrea

AU - Kim, Won-Keun

AU - Hamm, Christian

AU - Nombela Franco, Luis

AU - Mangieri, Antonio

AU - Schoels, Wolfgang H

AU - Barbanti, Marco

AU - Bunc, Matjaz

AU - Akodad, Myriama

AU - Rubinshtein, Ronen

AU - Danenberg, Haim

PY - 2023/4/17

Y1 - 2023/4/17

N2 - AIMS: Paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) is associated with increased morbidity and mortality. The effect of transcatheter interventions to treat PVR after the index TAVI was investigated.METHODS AND RESULTS: A registry of consecutive patients who underwent transcatheter intervention for ≥ moderate PVR after the index TAVI at 22 centers. The principal outcomes were residual aortic regurgitation (AR) and mortality at 1 year after PVR treatment. A total of 201 patients were identified: 87 (43%) underwent redo-TAVI, 79 (39%) plug closure, and 35 (18%) balloon valvuloplasty. Median TAVI-to-re-intervention time was 207 (35; 765) days. The failed valve was self-expanding in 129 (63.9%) patients. The most frequent devices utilized were a Sapien 3 valve for redo-TAVI (55, 64%), an AVP II as plug (33, 42%), and a True balloon for valvuloplasty (20, 56%). At 30 days, AR ≥ moderate persisted in 33 (17.4%) patients: 8 (9.9%) after redo-TAVI, 18 (25.9%) after plug, and 7 (21.9%) after valvuloplasty (P = 0.036). Overall mortality was 10 (5.0%) at 30 days and 29 (14.4%) at 1 year: 0, 8 (10.1%), and 2 (5.7%) at 30 days (P = 0.010) and 11 (12.6%), 14 (17.7%), and 4 (11.4%) at 1 year (P = 0.418), after redo-TAVI, plug, and valvuloplasty, respectively. Regardless of treatment strategy, patients in whom AR was reduced to ≤ mild had lower mortality at 1 year compared with those with AR persisting ≥ moderate [11 (8.0%) vs. 6 (21.4%); P = 0.007].CONCLUSION: This study describes the efficacy of transcatheter treatments for PVR after TAVI. Patients in whom PVR was successfully reduced had better prognosis. The selection of patients and the optimal PVR treatment modality require further investigation.

AB - AIMS: Paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) is associated with increased morbidity and mortality. The effect of transcatheter interventions to treat PVR after the index TAVI was investigated.METHODS AND RESULTS: A registry of consecutive patients who underwent transcatheter intervention for ≥ moderate PVR after the index TAVI at 22 centers. The principal outcomes were residual aortic regurgitation (AR) and mortality at 1 year after PVR treatment. A total of 201 patients were identified: 87 (43%) underwent redo-TAVI, 79 (39%) plug closure, and 35 (18%) balloon valvuloplasty. Median TAVI-to-re-intervention time was 207 (35; 765) days. The failed valve was self-expanding in 129 (63.9%) patients. The most frequent devices utilized were a Sapien 3 valve for redo-TAVI (55, 64%), an AVP II as plug (33, 42%), and a True balloon for valvuloplasty (20, 56%). At 30 days, AR ≥ moderate persisted in 33 (17.4%) patients: 8 (9.9%) after redo-TAVI, 18 (25.9%) after plug, and 7 (21.9%) after valvuloplasty (P = 0.036). Overall mortality was 10 (5.0%) at 30 days and 29 (14.4%) at 1 year: 0, 8 (10.1%), and 2 (5.7%) at 30 days (P = 0.010) and 11 (12.6%), 14 (17.7%), and 4 (11.4%) at 1 year (P = 0.418), after redo-TAVI, plug, and valvuloplasty, respectively. Regardless of treatment strategy, patients in whom AR was reduced to ≤ mild had lower mortality at 1 year compared with those with AR persisting ≥ moderate [11 (8.0%) vs. 6 (21.4%); P = 0.007].CONCLUSION: This study describes the efficacy of transcatheter treatments for PVR after TAVI. Patients in whom PVR was successfully reduced had better prognosis. The selection of patients and the optimal PVR treatment modality require further investigation.

KW - Aortic Valve Insufficiency/etiology

KW - Aortic Valve Stenosis

KW - Aortic Valve/diagnostic imaging

KW - Heart Valve Prosthesis

KW - Humans

KW - Prognosis

KW - Transcatheter Aortic Valve Replacement/methods

KW - Treatment Outcome

KW - TAVI

KW - Plug

KW - Paravalvular regurgitation (PVR)

KW - Redo-TAVI

KW - Valvuloplasty

UR - https://www.scopus.com/pages/publications/85152633036

U2 - 10.1093/eurheartj/ehad146

DO - 10.1093/eurheartj/ehad146

M3 - Journal article

C2 - 36883599

SN - 0195-668X

VL - 44

SP - 1331

EP - 1339

JO - European Heart Journal

JF - European Heart Journal

IS - 15

ER -

Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation: prognostic implications

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