TAV-in-TAV Outcomes: Experience from a Single Institution

Vol V Issue VI
DOI: 10.5083ejcm20424884.166 , Cite or Link Using DOI
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Jeremy R Burt, Ali M Agha, Madison Kocher, Aryan Zahergivar, Heather Collins,Usman Siddiqui

ABSTRACT Introduction: Dysfunction or malpositioning of the aortic valve prosthesis is an uncommon but a known complication. Deployment of a second transcatheter aortic valve within previously implanted transcatheter aortic valve prosthesis is referred to as TAV-in-TAV. This procedure is often performed to treat aortic regurgitation occurring shortly after transcatheter aortic valve replacement (TAVR). Objective: The purpose of our study was to see if TAVR approach (transfemoral vs. transapical) impacted the incidence of periprocedural TAVin-TAV. Methods: A retrospective record review of consecutive patients was performed at a single center. The incidence of periprocedural TAVin-TAV was recorded and compared between patients’ undergoing TAVR via transfemoral and transapical approach. Periprocedural complications and imaging findings were also recorded. Results: Out of 489 patients undergoing TAVR, only 10 patients (2%) required urgent periprocedural TAV-in-TAV, 5 patients each from the transfemoral and transapical groups (1.6% vs. 2.7%, respectively, p = 0.51). TAV-in-TAV deployment was technically successful in 8 patients (80%) and unsuccessful in 2 patients (20%; 1 transfemoral and 1 transapical), who required conversion to openheart surgery. The primary cause of TAVR failure requiring periprocedural TAV-in-TAV in both transfemoral and transapical patients was prosthesis malposition, frequently complicated by moderate to severe paravalvular aortic insufficiency. Statistically, there was no difference between the periprocedural morbidity and 30- day mortality for patients undergoing TAV-in-TAV via transfemoral versus transapical approach. Conclusion: Periprocedural TAV-in-TAV was uncommon in our cohort, primarily resulting from prosthesis malposition causing paravalvular aortic insufficiency. We found no difference in the number of patients requiring TAV-in-TAV in relation to TAVR approach.