Midterm outcomes after the rescue THV‐in‐THV procedure: Insights from the multicenter prospective OCEAN‐TAVI registry

Objectives To confirm whether the rescue transcatheter heart valve in the transcatheter heart valve (THV‐in‐THV) procedure is effective and feasible, we aimed to assess the midterm outcomes following rescue THV‐in‐THV procedures. The trends in the usage of the rescue THV‐in‐THV procedure at the time of transcatheter aortic valve implantation (TAVI) have also been explored. Background Midterm outcomes of the rescue THV‐in‐THV procedure have been poorly defined, though it is popular as an effective method to bail‐out some complications in TAVI. Methods We reviewed data from the Optimized transCathEter vAlvular iNtervention‐Transcatheter Aortic Valve Implantation (OCEAN‐TAVI) registry and compared the outcomes of TAVI with rescue THV‐in‐THV and TAVI without rescue THV‐in‐THV. We also examined the annual rates of rescue THV‐in‐THV procedures in all the TAVI procedures between 2013 and 2017. Results Among 2,588 patients who underwent TAVI, 26 patients have required rescue THV‐in‐THV for valve malposition (n = 23) or severe transvalvular regurgitation because of stuck THV leaflets (n = 3). Three cases needed an open conversion, and two died in the hospital. The rates of new permanent pacemaker implantation, acute kidney injury, and stroke were higher in the THV‐in‐THV group. A two‐year cumulative survival and echocardiographic outcomes succeeding rescue THV‐in‐THV procedure were comparable to non‐THV‐in‐THV cases. The rate of rescue THV‐in‐THV procedure lessened from 2.6% in 2013 to 0.6% in 2017. Conclusions The rescue THV‐in‐THV procedure is an effective and feasible option for THV malpositioning and stuck valve. It has given a comparable survival and a stable valve function over midterm observation periods.