Clinical Outcomes of Redo Transcatheter Aortic Valve Replacement According to Computed Tomography Sizing

BACKGROUND: The optimal sizing strategy for redo transcatheter aortic valve replacement (TAVR) on the basis of computed tomographic (CT) planning is currently debated. OBJECTIVES: The aim of this study was to describe real-world practice for CT sizing and its impact on clinical outcomes of redo-TAVR, according to Valve Academic Research Consortium 3 definitions. METHODS: Consecutive patients undergoing redo-TAVR with preprocedural CT planning were retrospectively analyzed. Measurements of the landing zone (LZ) within the index transcatheter aortic valve (TAV-1) were obtained. The selected size of the second valve (TAV-2) was compared with that suggested by LZ measurements, categorizing patients as LZ concordant (matching size) or LZ discordant (deviating size). RESULTS: Among 150 patients, TAV-1 compression was observed in 97.3% of cases. Overall, 52% of patients received LZ-discordant TAV-2 sizes, mostly resulting in a larger than recommended TAV-2 with 21.2% (15.8%-24.8%) oversizing to the LZ and 7.1% (3.1%-10.9%) to the annulus. No annular rupture events occurred. Device success at 30 days was 73.3%. Median follow-up was 368 days (Q1-Q3: 96-611 days). The estimated rate of bioprosthetic valve failure at 1 year was 8.7% (95% CI: 3.1%-14.2%), without significant differences between the 2 groups. LZ perimeter <62 mm (HR: 4.19; 95% CI: 1.37-12.8; P = 0.012) and TAV-2 size smaller than the manufacturer sizing range for the aortic annulus (HR: 3.75; 95% CI: 1.25-11.2; P = 0.018) were independent predictors of bioprosthetic valve failure. CONCLUSIONS: In patients undergoing redo-TAVR with preprocedural CT planning, a sizing strategy enabling selective TAV-2 oversizing relative to the LZ was associated with favorable outcomes without increased procedural complications. Larger studies are needed to confirm these findings.