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 1 publication

(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%