Alternative treatment option for high risk surgical candidates after previous cardiac surgery: The Scottish National TAVI Programme experience

Giordano, Vincenzo; Kar, Ashok; Flapan, Andrew D.; Uren, Neil; Prasad, Sai; Pessotto, Renzo

doi:10.1186/1749-8090-10-s1-a236

Cited by 2 publications

(2 citation statements)

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“…Surgical patients required a prolonged ICU and hospital stay. Similar results were reported by Giordano (p<0.001) and Wilbring (p=0.0216) [14,19]. Several studies have also confirmed greater complication rates for redo-AVR in comparison with valve-in-valve TAVI, including a higher rate of stroke, myocardial infarction, major bleeding complications and PPM implantation [13,15,16,20].…”

Section: Discussionsupporting

confidence: 76%

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

Gatta

Haqzad

Gradinariu

et al. 2023

Monaldi Arch Chest Dis

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This study sought to compare the morbidity and mortality of redo aortic valve replacement (redo-AVR) versus valve-in-valve trans-catheter aortic valve implantation (valve-in-valve TAVI) for patients with a failing bioprosthetic valve. A multicentre UK retrospective study of redo-AVR or valve-in-valve TAVI for patients referred for redo aortic valve intervention due to a degenerated aortic bioprosthesis. Propensity score matching was performed for confounding factors. From July 2005 to April 2021, 911 patients underwent redo-AVR and 411 patients valve-in-valve TAVI. There were 125 pairs for analysis after propensity score matching. Mean age was 75.2±8.5 years. In-hospital mortality was 7.2% (n=9) for redo-AVR vs 0 for valve-in-valve TAVI, p=0.002. Surgical patients suffered more post-operative complications, including IABP support (p=0.02), early re-operation (p<0.001), arrhythmias (p<0.001), respiratory and neurological complications (p=0.02 and p=0.03) and multi-organ failure (p=0.01). The valve-in-valve TAVI group had a shorter intensive care unit and hospital stay (p <0.001 for both). However, moderate aortic regurgitation at discharge and higher post-procedural gradients were more common after valve-in-valve TAVI (p<0.001 for both). Survival probabilities in patients who were successfully discharged from hospital were similar after valve-in-valve TAVI and redo-AVR over the 6-year follow-up (log-rank p=0.26). In elderly patients with a degenerated aortic bioprosthesis, valve-in-valve trans-catheter aortic valve implantation provides better early outcomes, as opposed to redo surgical aortic valve replacement, although there was no difference in mid-term survival in patients successfully discharged from hospital.

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Section: Discussionsupporting

confidence: 76%

“…Several studies report the feasibility of valve-in-valve TAVI compared with redo-AVR for severe bioprosthetic aortic valve dysfunction, but mid-and long-term results are limited and patient cohorts are small [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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

Gatta

Haqzad

Gradinariu

et al. 2023

Monaldi Arch Chest Dis

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Bioprosthetic Aortic Valve Degeneration After TAVR and SAVR: Incidence, Diagnosis, Predictors, and Management

Bismee,

Javadi,

Khedr

et al. 2024

JCDD

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Bioprosthetic aortic valve degeneration (BAVD) is a significant clinical concern following both transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). The increasing use of bioprosthetic valves in aortic valve replacement in younger patients and the subsequent rise in cases of BAVD are acknowledged in this review which aims to provide a comprehensive overview of the incidence, diagnosis, predictors, and management of BAVD. Based on a thorough review of the existing literature, this article provides an updated overview of the biological mechanisms underlying valve degeneration, including calcification, structural deterioration, and inflammatory processes and addresses the various risk factors contributing to BAVD, such as patient demographics, comorbidities, and procedural variables. The difficulties in early detection and accurate diagnosis of BAVD are discussed with an emphasis on the need for improved imaging techniques. The incidence and progression of BAVD in patients undergoing TAVR versus SAVR are compared, providing insights into the differences and similarities between the two procedures and procedural impacts on valve longevity. The current strategies for managing BAVD, including re-intervention options of redo surgery and valve-in-valve TAVR, along with emerging treatments are discussed. The controversies in the existing literature are highlighted to offer directions for future investigations to enhance the understanding and management of BAVD.

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Alternative treatment option for high risk surgical candidates after previous cardiac surgery: The Scottish National TAVI Programme experience

Cited by 2 publications

References 0 publications

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

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

Bioprosthetic Aortic Valve Degeneration After TAVR and SAVR: Incidence, Diagnosis, Predictors, and Management

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