Transcatheter valve-in-valve implantation resulted in similar 3-year survival compared to redo surgical aortic valve replacement (83.9% vs 93.0%, p=0.10) for bioprosthetic valve degeneration.
Cohort (n=88)
Does transcatheter valve-in-valve implantation improve early and midterm outcomes compared to redo surgical aortic valve replacement in patients with aortic bioprosthetic valve degeneration?
Transcatheter valve-in-valve implantation is a safe and feasible alternative to redo surgical aortic valve replacement for aortic bioprosthetic valve degeneration, offering similar midterm survival with lower rates of pacemaker implantation and shorter hospital stays.
Absolute Event Rate: 83.9% vs 93%
p-value: p=0.10
OBJECTIVE: To compare early and midterm outcomes of transcatheter valve-in-valve implantation (ViV-TAVI) and redo surgical aortic valve replacement (re-SAVR) for aortic bioprosthetic valve degeneration. DESIGN: Patients who underwent ViV-TAVI and re-SAVR for aortic bioprosthetic valve degeneration between January 2010 and October 2018 were retrospectively analyzed. Mean follow-up was 3.0 years. SETTING: In-hospital, early, and mid-term outcomes. PARTICIPANTS: Eighty-eight patients were included in the analysis. INTERVENTIONS: Thirty-one patients (37.3%) had ViV-TAVI, and 57 patients (62.7%) had re-SAVR. MEASUREMENTS AND MAIN RESULTS: In the ViV-TAVI group, patients were older (79.1 ± 7.4 v 67.2 ± 14.1, p 24 hours, total amount of chest tube losses, red blood cell transfusions, plasma transfusions, and reoperation for bleeding were significantly higher in the re-SAVR cohort (p < 0.01). There was no difference regarding in-hospital permanent pacemaker implantation (ViV-TAVI = 3.2% v re-SAVR = 8.8%, p = 0.27), patient-prosthesis mismatch (ViV-TAVI = 12 patients mean 0.53 ± 0.07 and re-SAVR = ten patients mean 0.56 ± 0.08, p = 0.4), stroke (ViV-TAVI = 3.2% v re-SAVR = 7%, p = 0.43), acute kidney injury (ViV-TAVI = 9.7% v re-SAVR = 15.8%, p = 0.1), and all-cause infections (ViV-TAVI = 0% v re-SAVR = 8.8%, p = 0.02), between the two groups. In-hospital mortality was 0% and 7% for ViV-TAVI and re-SAVR, respectively (p = 0.08). At three-years' follow-up, the incidence of pacemaker implantation was higher in the re-SAVR group (ViV-TAVI = 0 v re-SAVR = 13.4%, p < 0.01). There were no differences in reintervention (ViV-TAVI = 3.8% v re-SAVR = 0%, p = 0.32) and survival (ViV-TAVI = 83.9% v re-SAVR = 93%, p = 0.10) between the two cohorts. CONCLUSIONS: ViV-TAVI is a safe, feasible, and reliable procedure.
Dokollari et al. (Mon,) conducted a cohort in Aortic bioprosthetic valve degeneration (n=88). Transcatheter valve-in-valve implantation (ViV-TAVI) vs. Redo surgical aortic valve replacement (re-SAVR) was evaluated on 3-year survival (p=0.10). Transcatheter valve-in-valve implantation resulted in similar 3-year survival compared to redo surgical aortic valve replacement (83.9% vs 93.0%, p=0.10) for bioprosthetic valve degeneration.
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