Risk and Outcomes of Reintervention After Transcatheter Aortic Valve Implantation.

Abstract

Concerns about transcatheter aortic valve implantation (TAVI) durability and failure management are increasing. This study assessed the time-varying risk and outcomes of reintervention after TAVI in Medicare patients. Between 2013 and 2022, 2387 of 324,701 (0.7%) TAVI patients underwent reintervention. Bayesian survival analysis was used to identify 3 intervals based on the change in the hazard of reintervention after TAVI. Multivariable Bayesian models were used to assess the association between survival or heart failure hospitalizations and intervals controlling for relevant confounders. Three intervals of reintervention were identified: early, <3.5 years post TAVI; mid-term, 3.5 to <7 years; and late, ≥7 years. The hazard rate of reinterventions increased after TAVI from 0.26% during the early interval to 0.35% at mid-term and to 0.98% at the late interval. The most frequent cause for reintervention was valve stenosis, and it increased in mid-term (60.4%) and late (70.8%) intervals vs early (31.3%), P < .001. The rate of valve-in-valve procedures increased from 53.9% in the early interval to 79.6% in mid-term and to 97.2% in late interval. The 30-day and 1-year mortality risk was similar for all intervals. The adjusted risk of heart failure hospitalization was higher after early vs mid-term or late reinterventions. The hazard of reinterventions after TAVI increased over time with a major rise after 7 years. Mortality after reintervention was similar in different intervals; however, the heart failure risk of readmission was higher after early reinterventions. Post-TAVI care should be adapted to the increasing risk of reintervention over time.