December 15, 2020Philippine journal of cardiology.Open Access

Outcomes of Valve-in-Valve Transcatheter Aortic Valve Implantation Versus Conventional Redo Surgical Aortic Valve Replacement in Patients With Aortic Bioprosthetic Valves: A Meta-analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Aortic Bioprosthetic Valve Degeneration (n=533). Intervention: Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) vs. Conventional redo surgical aortic valve replacement (redo SAVR). Primary outcome: 30-day all-cause mortality (OR 1.16, 95% CI 0.50-2.70, p=0.65).

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Key result

ViV-TAVI yields comparable 30-day and procedural mortality versus redo SAVR.

OR 1.16
95% CI 0.50-2.70
P=0.65
n=533

Why the study?

Bioprosthetic aortic valve degeneration necessitates redo surgery, but outcomes comparing the novel alternative ViV-TAVI against redo SAVR needed evaluation.

Does ViV-TAVI reduce procedural and 30-day all-cause mortality compared to redo SAVR in patients with degenerated aortic bioprosthetic valves?

Population

533 patients across five studies with prior bioprosthetic SAVR

Comparison

ViV-TAVI vs redo SAVR

Design

Meta-analysis

Follow-up

12 or more months

Authors

KCKeith Andrew L Chan FCFrancisco L. Chio JAJeremy Anne A Alcazar

Discussion

Member takes

Overview

Supports ViV-TAVI as alternative with similar short-term mortality; extends meta-analytic evidence for degenerated bioprosthetic valves.

Study Design

Type

Meta-Analysis (n=533)

Structured PICO

Does ViV-TAVI reduce procedural and 30-day all-cause mortality compared to redo SAVR in patients with degenerated aortic bioprosthetic valves?

Population

533 patients with degenerated aortic bioprosthetic valves undergoing either valve-in-valve transcatheter aortic valve implantation or redo surgical aortic valve replacement, followed for 12 to 36 months.

Intervention

Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI)

Comparator

Conventional redo surgical aortic valve replacement (redo SAVR)

Outcome

Procedural and 30-day all-cause mortalityhard clinical

Main Result

Odds Ratio: 1.16 (95% CI 0.5–2.7)

Absolute Event Rate: 5.7% vs 4.6%

p-value: p=0.65

ViV-TAVI offers comparable procedural and 30-day mortality to redo SAVR in patients with degenerated bioprosthetic aortic valves, though it is associated with higher rates of elevated postoperative gradients and paravalvular leaks.

Limitations

Lack of randomized controlled trials; all included studies were observational.
Selection bias, as patients assigned to ViV-TAVI had significantly higher preoperative risk scores.
Postoperative valve hemodynamics may have been influenced by preexisting patient-prosthesis mismatch and paravalvular leaks.
Use of earlier device designs in the included studies may have contributed to increased aortic valve gradients and paravalvular leaks.

Cite This Study

Chan et al. (2020) conducted a meta-analysis in Aortic Bioprosthetic Valve Degeneration (n=533). Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) vs. Conventional redo surgical aortic valve replacement (redo SAVR) was evaluated on 30-day all-cause mortality (OR 1.16, 95% CI 0.50-2.70, p=0.65). Valve-in-valve transcatheter aortic valve implantation resulted in comparable 30-day all-cause mortality (OR 1.16) and procedural mortality compared to conventional redo surgical aortic valve replacement.

synapsesocial.com/papers/6aa2489d254b35ae1811552a https://doi.org/10.69944/pjc.164f82d17b

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December 15, 2020Philippine journal of cardiology.Open Access

Outcomes of Valve-in-Valve Transcatheter Aortic Valve Implantation Versus Conventional Redo Surgical Aortic Valve Replacement in Patients With Aortic Bioprosthetic Valves: A Meta-analysis

View Full Paper

Ask AI

Bookmark

Key result

ViV-TAVI yields comparable 30-day and procedural mortality versus redo SAVR.

OR 1.16
95% CI 0.50-2.70
P=0.65
n=533

Why the study?

Bioprosthetic aortic valve degeneration necessitates redo surgery, but outcomes comparing the novel alternative ViV-TAVI against redo SAVR needed evaluation.

Does ViV-TAVI reduce procedural and 30-day all-cause mortality compared to redo SAVR in patients with degenerated aortic bioprosthetic valves?

Population

533 patients across five studies with prior bioprosthetic SAVR

Comparison

ViV-TAVI vs redo SAVR

Design

Meta-analysis

Follow-up

12 or more months

Authors

KCKeith Andrew L Chan FCFrancisco L. Chio JAJeremy Anne A Alcazar

Discussion

Member takes

Overview

Supports ViV-TAVI as alternative with similar short-term mortality; extends meta-analytic evidence for degenerated bioprosthetic valves.

Study Design

Type

Meta-Analysis (n=533)

Structured PICO

Does ViV-TAVI reduce procedural and 30-day all-cause mortality compared to redo SAVR in patients with degenerated aortic bioprosthetic valves?

Population

Intervention

Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI)

Comparator

Conventional redo surgical aortic valve replacement (redo SAVR)

Outcome

Procedural and 30-day all-cause mortalityhard clinical

Main Result

Odds Ratio: 1.16 (95% CI 0.5–2.7)

Absolute Event Rate: 5.7% vs 4.6%

p-value: p=0.65

Limitations

Lack of randomized controlled trials; all included studies were observational.
Selection bias, as patients assigned to ViV-TAVI had significantly higher preoperative risk scores.
Postoperative valve hemodynamics may have been influenced by preexisting patient-prosthesis mismatch and paravalvular leaks.
Use of earlier device designs in the included studies may have contributed to increased aortic valve gradients and paravalvular leaks.

Cite This Study

synapsesocial.com/papers/6aa2489d254b35ae1811552a https://doi.org/10.69944/pjc.164f82d17b

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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