Comparison of in-hospital outcomes and readmissions for valve-in-valve transcatheter aortic valve replacement vs. reoperative surgical aortic valve replacement: a contemporary assessment of real-world outcomes
Key result
VIV-TAVR linked to ~59% lower 30-day mortality versus re-SAVR.
- OR 0.41
- 95% CI 0.23-0.74
- n=6,815
Why the study?
Contemporary head-to-head comparisons of 30-day outcomes and readmissions between VIV-TAVR and high-risk re-SAVR using large, multicentre national data were needed.
Does valve-in-valve transcatheter aortic valve replacement reduce 30-day mortality and morbidity compared to reoperative surgical aortic valve replacement in high-risk adult patients with degenerated bioprosthetic aortic valves?
Population
US adult patients with degenerated bioprosthetic aortic valves undergoing VIV-TAVR (n = 3443) or isolated re-SAVR (n = 3372)
Comparison
VIV-TAVR vs isolated re-SAVR
Design
Multicentre retrospective database study with propensity score matching
Follow-up
30 days
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The problem with using these administrative databases are that they do lack granular data, so they don't have any CT or echo information for example. This does provide some longitudinal follow-up, but it doesn't really give you the best sense of what things will look like long-term.”
SRSajjad RazaAssociate Director, UH RISES Center
“SAVR and valve-in-valve TAVR should not be seen as competitive procedures -- they should instead be seen as complementary. Depending on patient comorbidities, some patients may have better outcomes after SAVR, while other patients may fare better outcomes with valve-in-valve TAVR.”
“Not much data are available comparing the outcomes of valve-in-valve TAVR with reoperative SAVR. Though the short-term outcomes of the two procedures appear similar in limited data that is available, the long-term durability of valve-in-valve TAVR still needs to be evaluated.”
Overview
May support preferring valve-in-valve TAVR in high-risk patients; leaves open need for randomized confirmation of mortality benefit.
Key Points
- The aim is to compare 30-day outcomes and readmissions between valve-in-valve TAVR and reoperative surgical aortic valve replacement in high-risk patients.
- Utilized the 2012-16 National Readmission Database to identify patients with degenerated bioprosthetic aortic valves who underwent either VIV-TAVR or re-SAVR.
- Conducted multivariate analysis and propensity score matching (1:1) to compare outcomes.
- Sample sizes: VIV-TAVR (n=3443) and re-SAVR (n=3372), with 2181 matched pairs.
- VIV-TAVR patients had lower 30-day mortality (2.7% vs. 5.0%) and morbidity (66.4% vs. 79%).
- Post-matching, VIV-TAVR was associated with an odds ratio (OR) of 0.41 for 30-day mortality and OR 0.53 for morbidity versus re-SAVR.
- VIV-TAVR resulted in shorter lengths of stay (median savings of 2 days) and higher odds of routine home discharges (OR 2.11).
Study Design
Type
Cohort (n=6,815)
Multicenter
Yes
Structured PICO
Does valve-in-valve transcatheter aortic valve replacement reduce 30-day mortality and morbidity compared to reoperative surgical aortic valve replacement in high-risk adult patients with degenerated bioprosthetic aortic valves?
P
Population
6,815 US adult patients with degenerated bioprosthetic aortic valves undergoing VIV-TAVR or re-SAVR, evaluated for 30-day outcomes.
E
Exposure
Valve-in-valve transcatheter aortic valve replacement (VIV-TAVR)
C
Comparator
Isolated reoperative surgical aortic valve replacement (re-SAVR)
O
Outcome
30-day mortality and 30-day morbidityhard clinical
Main Result
Odds Ratio: 0.41 (95% CI 0.23–0.74)
Absolute Event Rate: 2.7% vs 5%
In high-risk patients with degenerated bioprosthetic aortic valves, VIV-TAVR is associated with significantly lower 30-day mortality, morbidity, and major bleeding compared to re-SAVR.
Limitations
- Lack of data on low- and intermediate-risk patients
- Lack of longer-term efficacy data
Cite This Study
Hirji et al. (2020) conducted a cohort in Degenerated bioprosthetic aortic valves (n=6,815). Valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) vs. Reoperative surgical aortic valve replacement (re-SAVR) was evaluated on 30-day mortality (OR 0.41, 95% CI 0.23-0.74). Valve-in-valve TAVR was associated with lower odds of 30-day mortality compared to reoperative surgical aortic valve replacement in matched patients (OR 0.41; 95% CI 0.23-0.74).