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April 19, 2023Monaldi Archives for Chest DiseaseOpen Access

Redo aortic valve replacement vs valve-in-valve trans-catheter aortic valve implantation: a UK propensity-matched analysis

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Key result

Valve-in-valve TAVI linked to 0% in-hospital mortality versus redo-AVR for degenerated bioprostheses.

  • P=0.002
  • n=1,322

Why the study?

The comparative morbidity and mortality outcomes of redo aortic valve replacement versus valve-in-valve TAVI for failing bioprosthetic valves were unclear.

Does valve-in-valve TAVI reduce morbidity and mortality compared to redo-AVR in patients with a degenerated aortic bioprosthesis?

Comparison

Redo aortic valve replacement versus valve-in-valve trans-catheter aortic valve implantation

Design

Multicenter UK retrospective propensity score matched cohort study

Follow-up

6 years

Authors

FGFrancesca GattaYHYama HaqzadGGGeorge Gradinariu

Discussion

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Overview

May support valve-in-valve TAVI to lower in-hospital mortality in observational cohorts; leaves open randomized confirmation before practice change.

Study Design

Type

Observational (n=1,322)

Multicenter

Yes

Structured PICO

Does valve-in-valve TAVI reduce morbidity and mortality compared to redo-AVR in patients with a degenerated aortic bioprosthesis?

P
Population
1,322 adult patients with a degenerated aortic bioprosthesis referred for redo intervention, from which 250 propensity-matched patients (mean age 75 years) were analyzed over a median follow-up of 3 to 4 years.
E
Exposure
Valve-in-valve trans-catheter aortic valve implantation (valve-in-valve TAVI)
C
Comparator
Redo aortic valve replacement (redo-AVR)
O
Outcome
In-hospital mortality and post-operative complicationshard clinical

Main Result

Absolute Event Rate: 0% vs 7.2%

p-value: p=0.002

Valve-in-valve TAVI offers superior early safety and lower in-hospital mortality compared to redo-AVR for degenerated bioprostheses, with comparable mid-term survival.

Limitations

  • Retrospective observational design
  • Small sample size in the propensity-matched cohort (125 pairs)
  • Differences in the era of intervention between the two groups, with most TAVI cases performed after 2014

Cite This Study

Gatta et al. (2023) conducted an observational in Degenerated aortic bioprosthesis (n=1,322). Valve-in-valve trans-catheter aortic valve implantation (TAVI) vs. Redo aortic valve replacement (redo-AVR) was evaluated on In-hospital mortality (p=0.002). Valve-in-valve trans-catheter aortic valve implantation was associated with 0% in-hospital mortality compared to 7.2% for redo aortic valve replacement in patients with a degenerated bioprosthesis.

synapsesocial.com/papers/6ab1dece99dd461dc2c8ea14https://doi.org/10.4081/monaldi.2023.2546
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