Impact of Repositioning the Latest Self‐Expanding Valves During Transcatheter Aortic Valve Implantation Procedures

BACKGROUND: Advances in transcatheter aortic valve implantation (TAVI) devices and techniques have been remarkable. Self-expanding valves (SEVs) possess the technical advantage of reposition (REP); however, research on their clinical impact remains limited. AIMS: This study aimed to investigate the impact of REP, including the latest SEVs. METHODS: This study included patients who underwent TAVI in Clinic Pasteur, France. The primary endpoint was the composite safety endpoint 30 days after TAVI. Other periprocedural safety outcomes and 1-year all-cause mortality were also evaluated. Subgroup analysis was performed to assess the independent risks for REP and early safety. RESULTS: Among 5628 patients, 3235 patients were included in the analysis. The REP group had a significantly younger age and a higher ejection fraction, suggesting lower operative risks. During TAVI, the REP group demonstrated significantly higher contrast volume, longer procedure duration, and fluoroscopic time than the non-REP group. The early safety and 1-year mortality were comparable between the groups (78.1% vs. 79.5%, p = 0.324; 5.1% vs. 5.4%, p = 0.668). The multivariate analysis showed that younger age, hemodialysis, aortic valve regurgitation ≥moderate, Navitor, and pre-dilatation were the independent risks for the need for REP. Regarding the early safety endpoint, previous pacemaker implantation was significantly associated with the achievement of early safety. REP was not associated with the early safety endpoint. CONCLUSIONS: The REP technique in SEVs was associated with favorable valve hemodynamic performance, maintaining safety compared to the non-REP group. However, potential risks of complications exist due to prolonged procedure times and increased contrast volume.