Nationally Representative Repeat Transcatheter Aortic Valve Replacement Outcomes: Report From the Centers for Medicare and Medicaid Services

Edward D. Percy, Morgan T. Harloff, Sameer Hirji, Siobhan McGurk, Farhang Yazdchi, Paige Newell, Alexandra Malarczyk, Ashraf Sabe, Uri Landes, John Webb, Michael J. Reardon, Vinod H. Thourani, Gilbert H.L. Tang, Vinayak Bapat, Deepak Bhatt, Patrick O'Gara, Thomas Gleason, Pinak Shah, Tsuyoshi Kaneko

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Objectives: The aim of this study was to examine real-world experience with repeat transcatheter aortic valve replacement (TAVR) in a population-based national database. Background: Repeat TAVR is a growing option in patients requiring reintervention for TAVR. However, large-scale studies with longitudinal follow-up are limited. Methods: All Medicare beneficiaries who underwent TAVR from 2012 to 2017 were included. Outcomes included 30-day and longitudinal mortality and major adverse cardiovascular events, defined as death, stroke, pacemaker insertion, major bleeding, acute kidney injury, or cardiac arrest. Outcomes of repeat TAVR were compared with surgical explantation after TAVR (TAVR explantation) in a matched analysis. Results: Of 133,250 patients who underwent TAVR, 617 (0.46%) underwent subsequent repeat TAVR at a median interval of 154 days (interquartile range: 58-537 days). Mortality at 30 days and 1 year was 6.0% and 22.0%, respectively. Rates of 30-day stroke and pacemaker insertion were 1.8% and 4.2%. Mortality at 30 days was lower in those who underwent their first TAVR during the later era (2015-2017) compared with earlier years (2012-2014) (4.6% vs 8.7%; P = 0.049). Repeat TAVR was associated with lower 30-day mortality compared with a matched group undergoing TAVR explantation (6.2% vs 12.3%; P = 0.05), although 1-year mortality was similar (21.0% vs 20.8%; P = 1.000). The incidence of 30-day major adverse cardiovascular events was higher with TAVR explantation compared with repeat TAVR (risk ratio: 2.92; 95% CI: 1.88-4.99; P ≤ 0.001). Conclusions: Repeat TAVR was performed with acceptable 30-day mortality in this high-risk population. Short-term outcomes were superior to surgical explantation, but 1-year outcomes were similar. Repeat TAVR will likely be an important option for aortic valve reintervention after TAVR.

Original languageEnglish
Pages (from-to)1717-1726
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume14
Issue number15
DOIs
StatePublished - 9 Aug 2021

Keywords

  • TAVR
  • TAVR explantation
  • repeat TAVR
  • surgical explant after TAVR
  • transcatheter aortic valve replacement

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