Giuseppe Tarantini, Luca Nai Fovino, Héctor Alfonso Alvarez Covarrubias, Rafał Wolny, Tommaso Fabris, Joanna Nawara Skipirzepa, Matthias Eden, Jose Luis Zamorano, Michael Joner, Thomas Cuisset, Victoria Delgado, Josep Rodés-Cabau, Francesco Saia, Gintautas Bieliauskas, Eric Van Belle, Thomas Modine, Tobias Rheude, Philippe GAROT, Christian Jung, Tanja K. Rudolph, Lionel Leroux, Wolfgang Rottbauer, Thomas Nestelberger, Thibault Lhermusier, Mohammed Nejjari, Ander Regueiro, David Meier, Chiara Fraccaro, Tau Hartikainen, Nicole Karam, Martin Swaans, Alberto Rodrigues, Henryk Dreger, Christian Hengstenberg, Thomas Schmitz, Sarah Mauler-Wittwer, Nicolò Piazza, Nicolas Combaret, Vincent Letocart, Vincent Auffret, Eric Durand, Marina Urena-Alcázar, Raquel Del Valle, Andrea Drago, Marco De Carlo, Víctor Alfonso Jiménez Díaz, Maciej Dąbrowski, Julia Mascherbauer, Arnaud Sudre, Peter Ong, Birgid Gonska, Massimo Mancone, Enrico Fabris, Rui Campante Teles, Luis Nombela-Franco, Lluís Asmarats, Victòria Vilalta, Marcin Protasiewicz, John Graydon Webb, Gabor Toth-Gayor, Andreas Zierer, Gilles Rioufol, Moritz Seiffert, Marianna Adamo, Francesco Meucci, Alfonso Ielasi, Francesco Burzotta, María López Benito, Itamar Loewenstein, Paweł Kralisz, Jacek Legutko, Zenon Huczek, Andrea Pavei, Radka Rakova, Wilbert Wesselink, Marie Zielinski, Nataliya Trushina, Peter Bramlage, Radoslaw Parma
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is increasingly performed in younger and lower-risk patients. Since many of these patients will outlive their transcatheter heart valve (THV), redo-TAVI procedures are expected to rise in number. Yet, real-world evidence on the procedural safety and efficacy of redo-TAVI remains limited. AIMS: We aimed to evaluate the 30-day procedural and clinical outcomes of redo-TAVI using the balloon-expandable SAPIEN 3 platform. METHODS: The ReTAVI registry is a prospective, international study enrolling consecutive patients with a failed aortic THV undergoing redo-TAVI with a balloon-expandable SAPIEN 3 THV. Data were collected across 59 international centres. All imaging was centrally analysed, and major clinical events were adjudicated by an independent committee. RESULTS: â¨A total of 143 patients (median age 84 years; 40.6% female; median Society of Thoracic Surgeons risk score 7.0%) were enrolled. The predominant failing THVs were balloon-expandable SAPIEN 3 (30.1%), self-expanding CoreValve/Evolut (53.1%), and ACURATE (14.0%) platforms. The most common failure mode was isolated regurgitation (48.6%), followed by stenosis (35.2%) and a mixed pathology (16.2%). The replacement valve was successfully implanted in 95.1% of patients, with a 30-day mortality rate of 3.5%. The 30-day stroke and pacemaker implantation rates were 0.7% and 6.3%, respectively. Redo-TAVI significantly improved valve haemodynamics, with mean gradients decreasing overall (Δ=-12.0 mmHg), and a more pronounced reduction in stenotic failures (Δ=-29.0 mmHg). Coronary obstruction was observed in 1.4% of cases. CONCLUSIONS: Redo-TAVI with a balloon-expandable SAPIEN 3 THV platform is a safe and effective reintervention strategy across diverse failed THV types, when guided by the Heart Team, standardised procedural planning, and comprehensive imaging. CLINICALTRIALS: gov: NCT05601453.