Characteristics and Outcomes of Patients Receiving a Second Rescue Valve During Transcatheter Aortic Valve Implantation

• Published in: Structural heart (Online) 2024-03, Vol.8 (2), p.100231-100231, Article 100231
• Main Authors: Bjursten, Henrik, Koul, Sasha, Pétursson, Pétur, Odenstedt, Jacob, Hagström, Henrik, Backes, Jenny, Nielsen, Niels Erik, Rück, Andreas, Johansson, Jan, James, Stefan, Settergren, Magnus, Götberg, Matthias, Yndigen, Troels
• Format: Article
• Language: English
• Subjects: Cardiac and Cardiovascular Systems; Clinical Medicine; Complication; Kardiologi; Kirurgi; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Original Research; Outcome; Surgery; Survival; TAVI
• ISSN: 2474-8706; 2474-8714; 2474-8714
• DOI: 10.1016/j.shj.2023.100231

Transcatheter aortic valve implantation (TAVI) has become a safe procedure. However, complications occur, including uncommon complications such as valve malposition, which requires the implantation of an additional rescue valve (rescue-AV). The aim was to study the occurrence and outcomes of rescue-AV in a nationwide registry. The Swedish national TAVI registry was used as the primary data source, where all 6706 TAVI procedures from 2016 to 2021 were retrieved. Nontransfemoral access and planned valve-in-valve were excluded. In total, 79 patients were identified as having had a rescue-AV, and additional detailed data were collected for these patients. This dataset was analyzed for any characteristics that could predispose patients to a rescue-AV. The outcome of patients receiving rescue-AV also was studied. Of the 5948 patients in the study, 1.3% had a rescue-AV. There were few differences between patients receiving 1 valve and rescue-AV patients. For patients receiving a rescue-AV, the 30-day mortality was 15.2% compared to 1.6% in the control group. A poor outcome after rescue-AV was often associated with a second complication; for example, stroke, need for emergency surgery, or heart failure. Among the patients with rescue-AV who survived at least 30 days, landmark analyses showed similar survival rates compared to the control group. Among TAVI patients in a nationwide register, rescue-AV occurred in 1.3% of patients. The 30-day mortality in patients receiving rescue-AV was high, but long-term outcome among 30-day survivors was similar to the control group. [Display omitted]