Key result
Valve-in-valve TAVI for failed surgical prostheses was not associated with a significantly different 5-year risk of death compared to native-valve TAVI (42.5% vs 44.8%; HR 0.79, 95% CI 0.62-1.00).
Why the study?
Valve-in-valve-TAVI is an increasingly used treatment for failed surgical aortic prostheses, but clinical practice data comparing outcomes to native-valve TAVI were limited.
Does valve-in-valve TAVI compared to native-valve TAVI affect short- and long-term mortality in patients undergoing TAVI?
Cohort (n=6,070)
Yes
Does valve-in-valve TAVI compared to native-valve TAVI affect short- and long-term mortality in patients undergoing TAVI?
Hazard Ratio: 0.79 (95% CI 0.62–1)
Absolute Event Rate: 42.5% vs 44.8%
Valve-in-valve TAVI for failed surgical aortic prostheses is a safe procedure with short- and long-term mortality comparable to native-valve TAVI.
Comparable long-term mortality with valve-in-valve versus native TAVI in this cohort; leaves open need for randomized confirmation.
BACKGROUND: Valve-in-valve-transcatheter aortic valve implantation (TAVI) is a feasible and increasingly used treatment option for failed surgical aortic prosthesis, but data from clinical practice are limited. We aimed to examine patient characteristics and outcomes of patients undergoing TAVI in a surgival valve (valve-in-valve TAVI) compared with patients undergoing TAVI in a native valve. METHODS: Using nationwide registries, we identified all Danish citizens, who underwent TAVI from January 1, 2008, to December 31, 2020. RESULTS: A total of 6,070 patients undergoing TAVI were identified; 247 (4%) patients had a history of SAVR (The valve-in-valve cohort). The median age of the study population was 81 (25th-75th percentile 77-85) and 55% were men. Patients with valve-in-valve-TAVI were younger but had a greater burden of cardiovascular comorbidities compared with patients with native-valve-TAVI. Within 30 days post procedure, 11 (0.2%) and 748 (13.8%) patients who underwent valve-in-valve-TAVI and native-valve-TAVI, respectively, had a pacemaker implantation. The cumulative 30-day risk of death among patients with valve-in-valve-TAVI was 2.4% (95% CI: 1.0%-5.0%) and 2.7% (95% CI: 2.3%-3.1%) in patients with native-valve-TAVI, respectively. Correspondingly, the cumulative 5-year risk of death was 42.5% (95% CI: 34.2%-50.6%) and 44.8% (95% CI: 43.2%-46.4%), respectively. In multivariable Cox proportional hazard analysis, valve-in-valve-TAVI was not associated with a significantly different risk of death at 30 days (Hazard ratio (HR) = 0.95, 95% CI 0.41-2.19) and 5 years (HR = 0.79, 95% CI 0.62-1.00) post-TAVI compared with native-valve-TAVI. CONCLUSIONS: TAVI in a failed surgical aortic prosthesis as compared to TAVI in a native valve, was not associated with significantly different short- and long-term mortality, suggesting that valve-in-valve-TAVI is a safe procedure.
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Begun et al. (2023) conducted a cohort in Failed surgical aortic prosthesis or native aortic valve disease requiring TAVI (n=6,070). Valve-in-valve TAVI vs. Native-valve TAVI was evaluated on 5-year risk of death (HR 0.79, 95% CI 0.62-1.00). Valve-in-valve TAVI for failed surgical prostheses was not associated with a significantly different 5-year risk of death compared to native-valve TAVI (42.5% vs 44.8%; HR 0.79, 95% CI 0.62-1.00).
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