Five-year follow-up from the CoreValve Expanded Use transcatheter aortic valve-in-surgical aortic valve study

Authors

Tanvir K. Bajwa, Advocate Aurora HealthFollow
Roger J. Laham, Department of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Kamal Khabbaz, Department of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Harold L. Dauerman, Department of Cardiovascular Medicine, University of Vermont, Burlington, VT, USA.
Ron Waksman, Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, USA.
Eric Weiss, Advocate Aurora HealthFollow
Suhail Allaqaband, Advocate Aurora HealthFollow
Salem Badr, Advocate Aurora Health
Michael Caskey, Department of Cardiothoracic Surgery and Interventional Cardiology, Arizona Heart Hospital, Phoenix, AZ, USA.
Timothy Byrne, Department of Cardiothoracic Surgery and Interventional Cardiology, Arizona Heart Hospital, Phoenix, AZ, USA.
Robert J. Applegate, Section of Cardiovascular Medicine and Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Neal D. Kon, Section of Cardiovascular Medicine and Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Shuzhen Li, Structural Heart and Aortic Statistics Department, Medtronic, Mounds View, MN, USA.
Neal S. Kleiman, Department of Cardiovascular Medicine and Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA.
Michael J. Reardon, Department of Cardiovascular Medicine and Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA.
Stanley J. Chetcuti, Department of Cardiology and Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA.
G Michael Deeb, Department of Cardiology and Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA.

Recommended Citation

Bajwa TK, Laham RJ, Khabbaz K, et al. Five-Year Follow-Up from the CoreValve Expanded Use Transcatheter Aortic Valve-in-Surgical Aortic Valve Study. Am J Cardiol. 2024;214:1-7. doi:10.1016/j.amjcard.2023.11.071

Affiliations

Aurora Sinai/Aurora St. Luke's Medical Centers

Abstract

Transcatheter aortic valve replacement (TAVR) provides an option for extreme-risk patients undergoing reoperation for a failed surgical aortic bioprosthesis. Long-term data in patients undergoing TAVR within a failed surgical aortic valve (TAV-in-SAV) are limited. The CoreValve Expanded Use Study evaluated patients at extreme surgical risk undergoing TAV-in-SAV. Outcomes at 5 years were analyzed by SAV failure mode (stenosis, regurgitation, or combined). Echocardiographic outcomes are site reported. TAV-in-SAV was attempted in 226 patients with a mean age of 76.7±10.8 years; 63.3% were male, the Society of Thoracic Surgeons predicted risk of mortality score was 9.0±6.7%, and 87.5% had NYHA classification III or IV symptoms. Most of the failed surgical bioprostheses were stented (81.9%), with an average implant duration of 10.2±4.3 years. The 5-year all-cause mortality or major stroke rate was 47.2% in all patients; 54.4% in the stenosis, 37.6% in the regurgitation, and 38.0% in the combined groups (p=0.046). At 5 years, all-cause mortality was higher in patients with vs without 30-day severe prosthesis patient mismatch (51.7% vs 38.3%, p=0.026). The overall aortic-valve reintervention rate was 5.9%; highest in the regurgitation group (12.6%). The mean aortic-valve gradient was 14.1±9.8mm Hg and effective orifice area was 1.57±0.70 at 5 years. Few patients had >mild paravalvular regurgitation at 5 years (5.5% moderate, 0.0% severe). TAV-in-SAV with supra-annular, self-expanding TAVR continues to represent a safe and lasting intermediate option for extreme-risk patients who have appropriate sizing of the preexisting failed surgical valve. Clinical and hemodynamic outcomes were stable through 5 years.

Type

Article

PubMed ID

38110018