Bibliographic Details
| Title: |
Hemodynamic and Clinical Outcomes in Redo-Surgical Aortic Valve Replacement vs. Transcatheter Valve-in-Valve |
| Authors: |
Sébastien Hecht, MSc, Anne-Sophie Zenses, PhD, Jérémy Bernard, MSc, Lionel Tastet, MSc, Nancy Côté, PhD, Leonardo de Freitas Campos Guimarães, MD, Jean-Michel Paradis, MD, Jonathan Beaudoin, MD, Kim O’Connor, MD, Mathieu Bernier, MD, Eric Dumont, MD, Dimitri Kalavrouziotis, MD, Robert Delarochellière, MD, Siamak Mohammadi, MD, Marie-Annick Clavel, DVM, PhD, Josep Rodés-Cabau, MD, Erwan Salaun, MD, PhD, Philippe Pibarot, DVM, PhD |
| Source: |
Structural Heart, Vol 6, Iss 6, Pp 100106- (2022) |
| Publisher Information: |
Elsevier, 2022. |
| Publication Year: |
2022 |
| Collection: |
LCC:Diseases of the circulatory (Cardiovascular) system |
| Subject Terms: |
Aortic bioprosthesis, Redo-surgery, Structural valve deterioration, Transcatheter valve-in-valve, Diseases of the circulatory (Cardiovascular) system, RC666-701 |
| More Details: |
Background: Transcatheter valve-in-valve replacement (ViV-TAVR) has emerged as an alternative to redo-surgical aortic valve replacement (Redo-SAVR) for the treatment of failed surgical aortic bioprostheses. However, the benefit of ViV-TAVR compared with Redo-SAVR remains debated with regard to short-term hemodynamic results and short- and long-term clinical outcomes. Objective: This study aimed to compare short-term hemodynamic performance and long-term clinical outcomes of ViV-TAVR vs. Redo-SAVR in patients treated for surgical aortic bioprosthetic valve failure. Methods: We retrospectively analyzed the data prospectively collected in 184 patients who underwent Redo-SAVR or ViV-TAVR. Transthoracic echocardiography was performed before and after the procedure and analyzed in an echocardiography core laboratory using the new Valve Academic Research Consortium-3 criteria. An inverse probability of treatment weighting was used to compare the outcomes between both procedures. Results: ViV-TAVR showed lower rate of intended hemodynamic performance (39.2% vs. 67.7%, p < 0.001) at 30 days, which was essentially driven by a higher rate (56.2% vs. 28.8%, p = 0.001) of high residual gradient (mean transvalvular gradient ≥20 mm Hg). Despite a trend for higher 30-day mortality in the Redo-SAVR vs. ViV-TAVR group (8.7% vs. 2.5%, odds ratio [95% CI]: 3.70 [0.77-17.6]; p = 0.10), the long-term mortality was significantly lower (24.2% vs. 50.1% at 8 years; hazard ratio [95% CI]: 0.48 [0.26-0.91]; p = 0.03) in the Redo-SAVR group. After inverse probability of treatment weighting analysis, Redo-SAVR remained significantly associated with reduced long-term mortality compared with ViV-TAVR (hazard ratio [95% CI]: 0.32 [0.22-0.46]; p < 0.001). Conclusions: ViV-TAVR was associated with a lower rate of intended hemodynamic performance and numerically lower mortality at 30 days but higher rates of long-term mortality compared with Redo-SAVR. |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
2474-8706 |
| Relation: |
http://www.sciencedirect.com/science/article/pii/S2474870622019017; https://doaj.org/toc/2474-8706 |
| DOI: |
10.1016/j.shj.2022.100106 |
| Access URL: |
https://doaj.org/article/a39b6455a1fe4998a127f0576ccd08a0 |
| Accession Number: |
edsdoj.39b6455a1fe4998a127f0576ccd08a0 |
| Database: |
Directory of Open Access Journals |
