Contemporary Outcome Trends in Transcatheter Aortic Valve-in-Valve Implantation Versus Redo Aortic Valve Replacement
Section snippets
Methods
All patients that underwent ViV or redo-SAVR for bioprosthetic valve deterioration between 2002 and 2020 at our center were retrospectively registered in a dedicated database. In the redo-SAVR group, only isolated SAVR cases were included (i.e., exclusion of combined procedures like SAVR + coronary artery bypass grafting). Patients <60 years and patients treated for infective endocarditis were excluded from the analysis.
Since the introduction of transcatheter aortic valve implantation (TAVI) at
Results
During the study, the number of reinterventions because of bioprosthetic aortic valve deterioration continuously increased over the past 2 decades. Between 2008 and 2010, <10 patients underwent reintervention because of prosthetic failure per year. From 2017 to 2020, this number increased to 30 cases per year. In total, 209 ViV and 65 redo-SAVR procedures were performed. Patient baseline characteristics are listed in Table 1. Patients with ViV were significantly older, had a higher EuroSCORE
Discussion
The main findings of the present analysis are as follows:
- 1.
Overall frequency of reinterventions for bioprosthetic aortic valve failure has increased over the last decade.
- 2.
Both ViV and redo-SAVR show low postprocedural stroke rates and 30-day mortality.
- 3
Despite a higher risk in the ViV group, 30-day mortality did not significantly differ between groups.
- 4.
ViV was associated with a beneficial rate of 30-day VARC-2 combined safety end point.
- 5.
VARC-2 clinical efficacy and device success rates are lower in
Conclusion
In the present analysis, both ViV and redo-SAVR were associated with low stroke rates and low 30-day mortality in a high-risk patient cohort. That 30-day mortality did not significantly differ between the groups before adjustment for baseline differences may imply a favorable short-term outcome for ViV. This is underlined by a significantly higher rate of VARC-2 combined safety in ViV patients. Although ViV treatment was associated with significantly lower rates of VARC-2 clinical efficacy and
Disclosures
The authors have no conflicts of interest to declare.
Acknowledgment
The authors thank LetPub.com for the help with formatting this text.
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This work is supported by the Clinician Scientist Programme of the German Center for Cardiovascular Research (DZHK) FKZ 81 × 3710109, Berlin, Germany.