Reinterventions After CoreValve/Evolut Transcatheter or Surgical Aortic Valve Replacement for Treatment of Severe Aortic Stenosis.
JACC Cardiovasc Interv
; 17(8): 1007-1016, 2024 Apr 22.
Article
in En
| MEDLINE
| ID: mdl-38573257
ABSTRACT
BACKGROUND:
Data on valve reintervention after transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) are limited.OBJECTIVES:
The authors compared the 5-year incidence of valve reintervention after self-expanding CoreValve/Evolut TAVR vs SAVR.METHODS:
Pooled data from CoreValve and Evolut R/PRO (Medtronic) randomized trials and single-arm studies encompassed 5,925 TAVR (4,478 CoreValve and 1,447 Evolut R/PRO) and 1,832 SAVR patients. Reinterventions were categorized by indication, timing, and treatment. The cumulative incidence of reintervention was compared between TAVR vs SAVR, Evolut vs CoreValve, and Evolut vs SAVR.RESULTS:
There were 99 reinterventions (80 TAVR and 19 SAVR). The cumulative incidence of reintervention through 5 years was higher with TAVR vs SAVR (2.2% vs 1.5%; P = 0.017), with differences observed early (≤1 year; adjusted subdistribution HR 3.50; 95% CI 1.53-8.02) but not from >1 to 5 years (adjusted subdistribution HR 1.05; 95% CI 0.48-2.28). The most common reason for reintervention was paravalvular regurgitation after TAVR and endocarditis after SAVR. Evolut had a significantly lower incidence of reintervention than CoreValve (0.9% vs 1.6%; P = 0.006) at 5 years with differences observed early (adjusted subdistribution HR 0.30; 95% CI 0.12-0.73) but not from >1 to 5 years (adjusted subdistribution HR 0.61; 95% CI 0.21-1.74). The 5-year incidence of reintervention was similar for Evolut vs SAVR (0.9% vs 1.5%; P = 0.41).CONCLUSIONS:
A low incidence of reintervention was observed for CoreValve/Evolut R/PRO and SAVR through 5 years. Reintervention occurred most often at ≤1 year for TAVR and >1 year for SAVR. Most early reinterventions were with the first-generation CoreValve and managed percutaneously. Reinterventions were more common following CoreValve TAVR compared with Evolut TAVR or SAVR.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Aortic Valve Stenosis
/
Postoperative Complications
/
Heart Valve Prosthesis Implantation
/
Transcatheter Aortic Valve Replacement
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Language:
En
Journal:
JACC Cardiovasc Interv
Journal subject:
ANGIOLOGIA
/
CARDIOLOGIA
Year:
2024
Type:
Article