Impact of Repositioning on Outcomes Following Transcatheter Aortic Valve Replacement With a Self-Expandable Valve

• Published in: JACC. Cardiovascular interventions Vol. 13; no. 15; pp. 1816 - 1824
• Main Authors: Attizzani, Guilherme F., Dallan, Luis Augusto P., Markowitz, Alan, Yakubov, Steven J., Deeb, G. Michael, Reardon, Michael J., Forrest, John K., Mangi, Abeel A., Huang, Jian, Popma, Jeffrey J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 10.08.2020
• Subjects: Aged; Aged, 80 and over; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Female; Heart Valve Prosthesis; Humans; Male; Multidetector Computed Tomography; Prosthesis Design; Randomized Controlled Trials as Topic; recapture; repositioning; resheath; Retrospective Studies; Risk Assessment; Risk Factors; self-expandable valve; Severity of Illness Index; Stroke - etiology; Stroke - mortality; TAVR; Time Factors; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - instrumentation; Transcatheter Aortic Valve Replacement - mortality; transcatheter heart valve; Treatment Outcome; LVEF; PPI; transcatheter heart valve; self-expandable valve; IQR; recapture; LVOT; MDCT; NRP; TAVR; CAS; repositioning; transcatheter aortic valve replacement; resheath; RP
• DOI: 10.1016/j.jcin.2020.04.028
• ISSN: 1936-8798; 1876-7605

This study sought to compare outcomes following transcatheter aortic valve replacement when valve repositioning was performed (repositioned group) versus procedures without repositioning (nonrepositioned group). The Evolut R and Evolut PRO valves were designed to allow repositioning during deployment, yet the effect of repositioning on clinical outcomes remains unclear. Patients implanted with the Evolut R or PRO valve from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial continued access study and the Evolut Low Risk Trial between June 2016 and November 2018 were combined. Baseline multidetector computed tomography data were analyzed for the Evolut Low Risk Trial patients. The primary outcomes were the rate of all-cause mortality and the rate of disabling stroke 30 days. Secondary outcomes were per Valve Academic Research Consortium-2. The Evolut R or PRO valve was implanted in 946 patients, and repositioning was performed in 318 (33.6%). Compared with patients in the nonrepositioned group, patients in the repositioned group had lower Society of Thoracic Surgeons score (2.3 ± 1.3% vs. 2.6 ± 1.4%; p < 0.001) and fewer prior percutaneous coronary interventions (11.9% vs. 19.7%; p = 0.003). There were no differences in baseline multidetector computed tomography parameters between groups. There were no differences in the primary outcome of death (0.3% vs. 0.3%; p = 0.99) or disabling stroke (0.3% vs. 0.5%; p = 0.71) at 30 days or 1 year (1.9% vs. 2.9%; p = 0.44; and 0.8% vs. 0.9%%; p = 0.79, respectively). The utilization of the repositioning feature of the Evolut valves was safe, and no differences in death or disabling stroke were observed at 30 days or 1 year between groups. (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients; NCT02701283; Safety and Efficacy Study of the Medtronic CoreValve® System In the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement [SURTAVI]; NCT01586910) [Display omitted]