TCT-929 Long-Term Outcomes Balloon-Expandable vs Self-Expandable Valves for Valve-in-Valve TAVR: Insight From Michigan Structural Heart Consortium

Document Type

Conference Proceeding

Publication Date

10-29-2024

Publication Title

J Am Coll Cardiol

Abstract

Background: Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) addresses issues with previously implanted aortic valves. Its use is growing because of the rise of bioprosthetic valves, high surgical reoperation risks, and expanding transcatheter aortic valve replacement (TAVR) indications. Both balloon-expandable (BE) and self-expandable (SE) valves are used, each with unique features and outcomes. Methods: We analyzed ViV TAVR patients from 2015 to 2022 using data from the Michigan Structural Heart Consortium and linked Medicare claims to extend the analysis of long-term mortality beyond the 1-year follow-up. Results: In our ViV TAVR cohort, 1,394 patients were analyzed comparing 683 BE and 711 SE valves. The cohort was predominantly male (70.3% vs 51.8%; P = 0.001) with lower Society of Thoracic Surgeons scores (4.17% vs 5.1%; P < 0.005). One-year post TAVR mortality was higher in SE valves (7.5% vs 6.4%; P < 0.018). Post-TAVR stroke, readmission, vascular complications, permanent pacemaker, and bleeding were similar between the groups. Severe patient-prosthesis mismatch was significantly higher in the BE cohort (47.9% vs 24.3%; P = 0.001). Three hundred forty cases (24%) were matched to Fee-for-Service Medicare, comprising 172 BE and 168 SE valves. Five-year post-TAVR survival was similar between the groups despite significant baseline differences. After the adjusted Cox regression model, there was no significant difference in survival between the groups (adjusted HR for SE vs BE: 1.03; 95% CI: 0.70-1.53; P = 0.88) (Figure). [Formula presented] Conclusion: In this real-world registry study, our findings showed no significant differences in in-hospital or long-term outcomes between patients with SE and BE valves following ViV TAVR. Categories: STRUCTURAL: Valvular Disease: Aortic.

Volume

84

Issue

18

First Page

B392

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