Contemporary Outcome Trends in Transcatheter Aortic Valve-in-Valve Implantation Versus Redo Aortic Valve Replacement

https://doi.org/10.1016/j.amjcard.2022.01.049Get rights and content

As valve-in-valve (ViV) transcatheter aortic valve implantation is still an evolving method, we evaluated the development of early and midterm outcomes after ViV and conventional redo-surgical aortic valve replacement (SAVR) over the past 2 decades. In-hospital databases were retrospectively screened for patients ≥60 years treated for failing bioprosthetic aortic valves at our center. Clinical and follow-up characteristics were compared between patients who underwent ViV or redo-SAVR according to valve academic research consortium-2 (VARC-2) definitions. The comparison of outcome parameters was adjusted for baseline differences between groups. Between June 2002 and April 2020, 209 patients with ViV and 65 redo-SAVR patients met inclusion criteria. No significant differences were found in 30 days (ViV 3.8%, SAVR 3.1%, p = 0.778) or 6-month mortality (ViV 14.0%, SAVR 7.5%, p = 0.283). As patients with ViV less frequently experienced acute kidney injury (stage II or III) and life-threatening bleeding, they more frequently reached the 30-day VARC-2 combined safety end point (79.2% vs 61.5%, odds ratio [OR] 2.540, p = 0.023). Patients with ViV less frequently reached clinical efficacy (68.3% vs 84.6%, OR 0.408, p = 0.041) and device success (79.9% vs 92.3%, OR 0.311, p = 0.040) end points, because of higher frequency of postprocedural transvalvular gradients >20 mm Hg. However, over the past decade, VARC-2 clinical efficacy and device success rates continuously increased in ViV cases. In conclusion, ViV and SAVR were associated with similar acute mortality and different beneficial and adverse outcome profiles in this single-center cohort. Results after ViV procedures have continuously improved over the past years.

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.

References (20)

There are more references available in the full text version of this article.

Cited by (0)

This work is supported by the Clinician Scientist Programme of the German Center for Cardiovascular Research (DZHK) FKZ 81 × 3710109, Berlin, Germany.

View full text