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September 14, 2021The Thoracic and Cardiovascular SurgeonOpen Access

Valve-in-Valve TAVR versus Redo Surgical Aortic Valve Replacement: Early Outcomes

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Key result

ViV-TAVR linked to ~18% lower absolute in-hospital mortality versus rSAVR.

  • P<0.001
  • n=90

Why the study?

Short-term outcomes of patients with failed aortic valve bioprosthesis undergoing valve-in-valve TAVR versus redo surgical aortic valve replacement were not well characterized.

Does ViV-TAVR reduce in-hospital all-cause mortality compared to rSAVR in patients with failed aortic valve bioprosthesis?

Population

90 patients with failed aortic valve bioprosthesis excluding endocarditis or combined surgery

Comparison

Valve-in-valve TAVR (n=73) vs redo surgical aortic valve replacement (n=17)

Design

Cohort study

Follow-up

In-hospital

Authors

ACAmila CizmicEKElmar KuhnKEKaveh Eghbalzadeh

Discussion

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Overview

ViV-TAVR may serve as alternative in selected patients; leaves open need for randomized trials on long-term outcomes.

Key Points

  • To compare the early clinical outcomes and in-hospital mortality of valve-in-valve transcatheter aortic valve replacement against redo surgical aortic valve replacement in patients with degenerated aortic bioprostheses.
  • Retrospective comparative analysis of 90 patients treated between 2009 and 2019 for failed aortic valve bioprostheses with either ViV-TAVR (n = 73) or rSAVR (n = 17).
  • Patients presenting with active endocarditis or requiring concomitant cardiac surgery were excluded.
  • In-hospital all-cause mortality was significantly lower in the ViV-TAVR cohort compared to the rSAVR cohort (0% vs. 17.6%, p < 0.001).
  • Paravalvular leak occurred in 52.1% of patients undergoing ViV-TAVR compared with 0% of those undergoing rSAVR (p < 0.001).
  • ViV-TAVR recipients were older (78.0 ± 7.4 vs. 62.1 ± 16.2 years, p = 0.012) with higher baseline comorbidity rates, whereas rSAVR patients had ICU stays more frequently complicated by blood transfusions without differences in cerebrovascular events.

Study Design

Type

Cohort (n=90)

Structured PICO

Does ViV-TAVR reduce in-hospital all-cause mortality compared to rSAVR in patients with failed aortic valve bioprosthesis?

P
Population
90 patients with failed aortic valve bioprosthesis undergoing ViV-TAVR or rSAVR, excluding those with endocarditis or needing combined cardiac surgery, assessed for short-term outcomes.
E
Exposure
Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) (n=73)
C
Comparator
Redo surgical aortic valve replacement (rSAVR) (n=17)
O
Outcome
In-hospital all-cause mortalityhard clinical

Main Result

Absolute Event Rate: 0% vs 17.6%

p-value: p=<0.001

ViV-TAVR is associated with lower in-hospital mortality but higher rates of paravalvular leak compared to redo SAVR in patients with failed aortic bioprostheses.

Cite This Study

Cizmic et al. (2021) conducted a cohort in Failed aortic valve bioprosthesis (n=90). Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) vs. Redo surgical aortic valve replacement (rSAVR) was evaluated on In-hospital all-cause mortality (p=<0.001). Valve-in-valve TAVR was associated with significantly lower in-hospital all-cause mortality compared to redo surgical aortic valve replacement (0% vs 17.6%, p<0.001).

synapsesocial.com/papers/6aaf2e9974b24cee3ca5efbehttps://doi.org/10.1055/s-0041-1735476
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