Key result
ViV-TAVI yields comparable 30-day and procedural mortality versus redo SAVR.
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?
Meta-Analysis (n=533)
Does ViV-TAVI reduce procedural and 30-day all-cause mortality compared to redo SAVR in patients with degenerated aortic bioprosthetic valves?
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.
Answers are grounded in this paper and cite their sources.
Supports ViV-TAVI as alternative with similar short-term mortality; extends meta-analytic evidence for degenerated bioprosthetic valves.
BACKGROUND: Studies have demonstrated earlier valve degeneration in patients with bioprosthetic aortic valves (AVs), necessitating redo surgical aortic valve replacement (SAVR). Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is a novel, off-label technique that offers a feasible alternative to SAVR. OBJECTIVES: The aim of this study was to determine outcomes of patients with bioprosthetic AVs undergoing ViV-TAVI versus redo SAVR, namely, primary clinical outcomes (procedural and 30-day all-cause mortality), secondary clinical outcomes (30-day myocardial infarction, stroke, acute kidney injury, permanent pacemaker insertion), and echocardiographic parameters (mean postoperative AV gradient, postoperative AV gradients >20 mm Hg, and paravalvular leaks). STUDY SELECTION: Criteria included studies having (a) human subjects, (b) recently conducted studies (publication date within 5 years from analysis), (c) patients with prior SAVR with a bioprosthetic valve, (d) both a ViV-TAVI compared against a redo SAVR arm, (e) follow-up period of 12 or more months, and (f) reported the specified outcomes. RESULTS: The analysis included five studies (total: 533 [ViV-TAVI: 249, redo SAVR: 284]). Preoperative risk scores were higher in the ViV-TAVI arm (EuroSCORE: 13 ± 10.4 to 27.4 ± 18.7; Society of Thoracic Surgeons [STS]: 7.4 ± 4.9 to 7.5 ± 3) compared with the redo SAVR arm (EuroSCORE: 8.9 ± 6.5 to 16.8 ± 9.3; STS: 4.4 ± 4.4 to 7.7 ± 3.4). There was no statistically significant difference for procedural and 30-day all-cause mortality. There were also no significant differences in any of the secondary clinical outcomes. Mean postoperative AV gradients had no significant differences between arms, but cases with postoperative AV gradients >20 mm Hg (odds ratio [OR], 5.26; 95% confidence interval [CI], 3.03–9.14; P < 0.00001) and paravalvular leaks (OR, 4.27; 95% CI, 2.01–9.07; P = 0.0002) were significantly higher in the ViV-TAVI group. CONCLUSION: Valve-in-valve transcatheter AV implantation is a novel technique being increasingly performed, with procedural and 30-day mortality rates comparable to redo SAVR, even in patients with high preoperative risk. However, its strongest limitation is postoperative valve hemodynamics, with redo SAVR still having a superior postoperative hemodynamic profile.
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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 and procedural mortality compared to conventional redo surgical aortic valve replacement.
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