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

Abstract

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.

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

“…The overall OR for operative mortality (Supporting Information: Figure ) demonstrated a statistically significant difference favoring ViV‐TAVR over redo SAVR (random‐effects model: OR: 0.37; 95% CI: 0.27–0.49; p < .001) 6,9,12,14,15,17–19,22,24 . There was no evidence of heterogeneity among studies reporting on operative mortality.…”

“…Of these, 115 relevant articles were read in full and assessed according to our inclusion and exclusion criteria. Following the critical appraisal, a total of 18 studies 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 incorporating a total of 11,198 patients were included. The studies described outcomes of patients undergoing either ViV‐TAVR (5676 patients) or redo SAVR (6322 patients).…”

“…ViV‐TAVR was compared to redo SAVR in 15 studies 6 , 8 , 9 , 10 , 11 , 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 22 , 23 reporting on stroke outcomes postoperatively (Figure 2B ). The overall OR for stroke showed no statistically significant difference between ViV‐TAVR and redo SAVR (random‐effects model: OR: 0.98; 95% CI: 0.80–1.20; p = .85).…”

“…The overall OR for operative mortality (Supporting Information: Figure 8A) demonstrated a statistically significant difference favoring ViV-TAVR over redo SAVR (random-effects model: OR: 0.37; 95% CI: 0.27-0.49; p < .001). 6,9,12,14,15,[17][18][19]22,24 There was no evidence of heterogeneity among studies reporting on operative mortality. The overall OR for 30-day mortality (Supporting Information: Figure 8B) showed no statistically significant difference between ViV-TAVR and redo SAVR (random-effects model: OR: 0.92; 95% CI: 0.53-1.60; p = .78).…”

“…The overall OR for 30-day mortality (Supporting Information: Figure 8B) showed no statistically significant difference between ViV-TAVR and redo SAVR (random-effects model: OR: 0.92; 95% CI: 0.53-1.60; p = .78). 6,[8][9][10][11][12]14,16,[18][19][20][21]23 There was evidence of moderate heterogeneity among studies reporting on 30-day mortality.…”