Does valve in valve TAVR carry a higher risk for thromboembolic events compared to native valve TAVR?

Abstract

Objective To evaluate the risk for brain lesions in valve in valve (VIV)‐transcatheter aortic valve replacement (TAVR) compared to native valve procedures (NV‐TAVR). Background TAVR is associated with the risk of stroke and a high incidence of brain lesions in diffusion‐weighted magnetic resonance imaging (DW‐MRI). The risk in VIV procedures is unknown. Methods Patients were included, if they received a Sapien‐3 or an Evolut‐R valve for an NV‐TAVR or VIV‐TAVR and a DW‐MRI within 3–5 days after the procedure. Results Two hundred nine patients had NV‐TAVR and 41 patients had VIV‐TAVR. The VIV group was significantly younger (mean 82.3 vs. 74.7 years old, p < .001) but had higher mean EuroSCORE II (4.8 vs. 7.8, p < .001). Predilatation was significantly more common with native valve (39% vs. 2%, p < .01), postdilatation rate was lower in VIV but without statistical significance (17% vs. 7%, p = .110). Combined in‐hospital safety outcome was comparable [13(6.6%) vs. 5(12.2%), p = .205]. Any stroke was documented in four (0.5%) patients after native valve and in one (2.4%) after VIV‐TAVR. New DW‐MRI brain lesions were significantly more often found in patients with native valves [153(73.2%) vs. 21(51.2%), p = .005], mean number of new lesions was also higher with native valve (2.8 ± 3.2 vs. 1.0 ± 1.4, p < .001). Forward stepwise of logistic regression found age and post dilatation significant predictors of new MRI lesions. Conclusions Compared to native valves, VIV procedures were associated with lower incidence and number of brain lesions according to DW‐MRI; these were explained by lower patients' age and lower rate of postdilatation.

Valve-in-Valve Transcatheter Aortic Valve Replacement in a High-Risk Patient with a Biocor Bioprosthesis and a Flail Prosthetic Valve Leaflet

“…In addition to PPM, each patient's stroke risk should be individually assessed. ViV TAVR stroke risk has not been fully established, but recent studies do not show any increased stroke risk in comparison with native valve TAVR [18]. Use of the SENTINEL embolic protection device in TAVR procedures has been reported to significantly lower the risk of stroke, death, and major bleeding at 30 days [19].…”

Valve-in-valve transcatheter aortic valve implantation after failed surgically implanted aortic bioprosthesis versus native transcatheter aortic valve implantation for aortic stenosis: Data from a nationwide analysis

“…Lower risk of cerebral ischaemic events on magnetic resonance imaging has been reported after VIV TAVI compared with native aortic valve TAVI [28]. The perprocedural risk of stroke associated with TAVI is mainly related to embolization of either aortofemoral or aortic valve material (usually heavily calcified foreign tissue in case of VIV procedure).…”

Incidence, Risk Factors, and Outcomes of Coronary Obstruction Following Valve-in-Valve Transcatheter Aortic Valve Replacement

“…Given the publication bias, CO mortality was lower in the present study than in real-world studies. It is noteworthy that patients were younger but had higher STS scores and Logistic Euro-SCORE in VIV-TAVR than in the native-TAVR; 24,25) therefore, it is not surprising that patients who underwent VIV had a higher mortality. In the present study, we could infer from the CO mortality description that those who were treated by PCI were more likely to survive the complica- tion.…”