Key result
Redo-surgical aortic valve replacement was associated with significantly reduced long-term mortality compared with transcatheter valve-in-valve replacement (HR 0.32; 95% CI 0.22-0.46; P<0.001).
Why the study?
The benefit of ViV-TAVR compared with Redo-SAVR remained debated regarding short-term hemodynamic results and short- and long-term clinical outcomes in patients with failed surgical aortic bioprostheses.
Does ViV-TAVR improve short-term hemodynamic performance and long-term mortality compared to Redo-SAVR in patients with surgical aortic bioprosthetic valve failure?
Cohort (n=184)
Does ViV-TAVR improve short-term hemodynamic performance and long-term mortality compared to Redo-SAVR in patients with surgical aortic bioprosthetic valve failure?
Hazard Ratio: 0.32 (95% CI 0.22–0.46)
Absolute Event Rate: 24.2% vs 50.1%
p-value: p=<0.001
In patients with failed surgical aortic bioprostheses, Redo-SAVR is associated with better short-term hemodynamic performance and significantly lower long-term mortality at 8 years compared to ViV-TAVR, despite a trend toward higher 30-day mortality.
ViV-TAVR was associated with inferior hemodynamics and higher long-term mortality; leaves open optimal strategy pending randomized trials.
Background Transcatheter valve-in-valve replacement (ViV-TAVR) has emerged as an alternative to redo-surgical aortic valve replacement (Redo-SAVR) for the treatment of failed surgical aortic bioprostheses. However, the benefit of ViV-TAVR compared with Redo-SAVR remains debated with regard to short-term hemodynamic results and short- and long-term clinical outcomes. Objective This study aimed to compare short-term hemodynamic performance and long-term clinical outcomes of ViV-TAVR vs. Redo-SAVR in patients treated for surgical aortic bioprosthetic valve failure. Methods We retrospectively analyzed the data prospectively collected in 184 patients who underwent Redo-SAVR or ViV-TAVR. Transthoracic echocardiography was performed before and after the procedure and analyzed in an echocardiography core laboratory using the new Valve Academic Research Consortium-3 criteria. An inverse probability of treatment weighting was used to compare the outcomes between both procedures. Results ViV-TAVR showed lower rate of intended hemodynamic performance (39.2% vs. 67.7%, p < 0.001) at 30 days, which was essentially driven by a higher rate (56.2% vs. 28.8%, p = 0.001) of high residual gradient (mean transvalvular gradient ≥20 mm Hg). Despite a trend for higher 30-day mortality in the Redo-SAVR vs. ViV-TAVR group (8.7% vs. 2.5%, odds ratio [95% CI]: 3.70 [0.77-17.6]; p = 0.10), the long-term mortality was significantly lower (24.2% vs. 50.1% at 8 years; hazard ratio [95% CI]: 0.48 [0.26-0.91]; p = 0.03) in the Redo-SAVR group. After inverse probability of treatment weighting analysis, Redo-SAVR remained significantly associated with reduced long-term mortality compared with ViV-TAVR (hazard ratio [95% CI]: 0.32 [0.22-0.46]; p < 0.001). Conclusions ViV-TAVR was associated with a lower rate of intended hemodynamic performance and numerically lower mortality at 30 days but higher rates of long-term mortality compared with Redo-SAVR.
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Hecht et al. (2022) conducted a cohort in surgical aortic bioprosthetic valve failure (n=184). Redo-surgical aortic valve replacement (Redo-SAVR) vs. Transcatheter valve-in-valve replacement (ViV-TAVR) was evaluated on long-term mortality (HR 0.32, 95% CI 0.22-0.46, p=<0.001). Redo-surgical aortic valve replacement was associated with significantly reduced long-term mortality compared with transcatheter valve-in-valve replacement (HR 0.32; 95% CI 0.22-0.46; P<0.001).
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