Meta-Analysis of Valve-in-Valve Transcatheter Aortic Valve Implantation Versus Redo-surgical Aortic Valve Replacement in Failed Bioprosthetic Aortic Valve

Al-abcha, Abdullah; Saleh, Yehia; Boumegouas, Manel; Prasad, Rohan; Herzallah, Khader; Baloch, Zulfiqar Qutrio; Abdelkarim, Ola; Rayamajhi, Supratik; Abela, George S.

doi:10.1016/j.amjcard.2021.01.028

Cited by 24 publications

(25 citation statements)

References 22 publications

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“…This finding is in line with the most recent meta‐analyses on this topic. In their pooled‐analysis of 8430 patients, Al‐abcha et al 23 reported a 30‐day survival benefit for ViV TAVR (OR, 0.58; 95% CI 0.45–0.74; p < .0001). Similarly, Sá et al 24 reported lower 30‐day mortality for ViV TAVR patients compared to Redo SAVR (OR, 0.53; 95% CI, 0.32–0.87; p = .017).…”

Section: Discussionmentioning

confidence: 99%

Valve‐in‐valve transcatheter aortic valve replacement versus redo surgical aortic valve replacement: A systematic review and meta‐analysis

Ahmed

Levy

2021

Journal of Cardiac Surgery

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Background/Aim: With the growing contemporary use of bioprosthetic valves, whose limited long-term durability has been well-documented, an increase in the need for reintervention is expected. We perform a meta-analysis to compare the current standard of care, redo surgical aortic valve replacement (Redo SAVR) with the less invasive alternative, valve-in-valve transcatheter aortic valve replacement (ViV TAVR) for treating structural valve deterioration.Methods: After a comprehensive literature search, studies comparing ViV TAVR to Redo SAVR were pooled to perform a pairwise meta-analysis using the randomeffects model. Primary outcomes were 30-day and follow-up mortality.Results: A total of nine studies including 9127 patients were included. ViV TAVR patients were significantly older (mean difference [MD], 5.82; p = .0002) and more frequently had hypercholesterolemia (59.7 vs. 60.0%; p = .0006), coronary artery disease (16.1 vs. 16.1%; p = .04), periphery artery disease (15.4 vs. 5.7%; p = .004), chronic obstructive pulmonary disease (29.3 vs. 26.2%; p = .04), renal failure (30.2 vs. 24.0%; p = .009), and >1 previous cardiac surgery (23.6 vs. 15.9%; p = .004).Despite this, ViV TAVR was associated with decreased 30-day mortality (OR, 0.56; p < .0001). Conversely, Redo SAVR had lower 30-day paravalvular leak (OR, 6.82; p = .04), severe patient-prosthesis mismatch (OR, 3.77; p < .0001), and postoperative aortic valve gradients (MD, 5.37; p < .0001). There was no difference in follow-up mortality (HR, 1.02; p = .86).Conclusions: Despite having patients with an increased baseline risk, ViV TAVR was associated with lower 30-day mortality, while Redo SAVR had lower paravalvular leak, severe patient-prosthesis mismatch, and postoperative gradients. Although ViV TAVR remains a feasible treatment option in high-risk patients, randomized trials are necessary to elucidate its efficacy over Redo SAVR.

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Section: Discussionmentioning

confidence: 99%

Valve‐in‐valve transcatheter aortic valve replacement versus redo surgical aortic valve replacement: A systematic review and meta‐analysis

Ahmed

Levy

2021

Journal of Cardiac Surgery

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“…In addition, based on the largest meta-analysis to date (8340 patients), Al-Abacha et al. concluded that midterm all-cause mortality (mean 1.7 years, OR 1.15, 95% CI 0.93–1.43) and 30-day pacemaker implantation (OR 0.75, 95% CI 0.42–1.34) were similar between ViV-TAVI and redo-SAVR patients [ 19 ]. Interestingly, Al-Abacha et al.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, Al-Abacha et al. described a lower procedural and 30-day mortality rate in favour of ViV-TAVI patients (OR 0.41, 95% CI 0.18–0.96 vs OR 0.58, 95% CI 0.45–0.74), which the authors attributed to the invasiveness of redo-SAVR combined with comorbidities and high surgical risk [ 19 ]. Nevertheless, diversity of the included populations and the retrospective design of the included studies may have introduced significant bias.…”

Section: Discussionmentioning

confidence: 99%

Report on outcomes of valve-in-valve transcatheter aortic valve implantation and redo surgical aortic valve replacement in the Netherlands

et al. 2021

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Objective We sought to investigate real-world outcomes of patients with degenerated biological aortic valve prostheses who had undergone valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) or reoperative surgical aortic valve replacement (redo-SAVR) in the Netherlands. Methods Patients who had undergone ViV-TAVI or redo-SAVR for a degenerated biological aortic valve prosthesis in the Netherlands between January 2014 and December 2018 were eligible for this retrospective study. Patients with a prior homograft, active endocarditis or mechanical aortic valve prosthesis were excluded. Patients were matched using the propensity score. The primary endpoint was a composite of 30-day all-cause mortality and in-hospital postoperative stroke. Secondary endpoints were all-cause mortality at different time points, in-hospital postoperative stroke, pacemaker implantation and redo procedures within one year. Baseline characteristics and outcome data were collected from the Netherlands Heart Registration. Results From 16 cardiac centres, 653 patients were included in the study (374 ViV-TAVI and 279 redo-SAVR). European System for Cardiac Operative Risk Evaluation I (EuroSCORE I) was higher in ViV-TAVI patients (19.4, interquartile range (IQR) 13.3–27.9 vs 13.8, IQR 8.3–21.9, p < 0.01). After propensity score matching, 165 patients were matched with acceptable covariate balance. In the matched cohorts, the primary endpoint was not significantly different for ViV-TAVI and redo-SAVR patients (odds ratio 1.30, 95% confidence interval 0.57–3.02). Procedural, 30-day and 1‑year all-cause mortality rates, incidence of in-hospital postoperative stroke, pacemaker implantation and redo procedures within one year were also similar between cohorts. Conclusion Patients with degenerated aortic bioprostheses treated with ViV-TAVI or redo-SAVR have similar mortality and morbidity.

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“…Again, the mean transvalvular pressure gradient was significantly higher post-implantation in the ViV-TAVR group when compared with the Redo-SAVR arm. In a follow-up period of 1.74 years, ViV-TAVR was associated with a similar risk of allcause mortality, cardiovascular mortality, myocardial infarction, permanent pacemaker implantation, and the rate of moderate to severe PVL, compared to redo SAVR (106). Interestingly, THV in THV showed more favorable results compared to THV in SAV.…”

Section: Viv Tavr Vs Redo Savr and Thv In Thvmentioning

confidence: 91%

Challenging Anatomies for TAVR—Bicuspid and Beyond

Saad

Seoudy

Frank

2021

Front. Cardiovasc. Med.

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Transcatheter aortic valve replacement has emerged as the standard treatment for the majority of patients with symptomatic aortic stenosis. As transcatheter aortic valve replacement expands to patients across all risk groups, optimal patient selection strategies and device implantation techniques become increasingly important. A significant number of patients referred for transcatheter aortic valve replacement present with challenging anatomies and clinical indications that had been historically considered a contraindication for transcatheter aortic valve replacement. This article aims to highlight and discuss some of the potential obstacles that are encountered in clinical practice with a particular emphasis on bicuspid aortic valve disease.

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Meta-Analysis of Valve-in-Valve Transcatheter Aortic Valve Implantation Versus Redo-surgical Aortic Valve Replacement in Failed Bioprosthetic Aortic Valve

Cited by 24 publications

References 22 publications

Valve‐in‐valve transcatheter aortic valve replacement versus redo surgical aortic valve replacement: A systematic review and meta‐analysis

Valve‐in‐valve transcatheter aortic valve replacement versus redo surgical aortic valve replacement: A systematic review and meta‐analysis

Report on outcomes of valve-in-valve transcatheter aortic valve implantation and redo surgical aortic valve replacement in the Netherlands

Challenging Anatomies for TAVR—Bicuspid and Beyond

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