Redo‐aortic valve replacement in prior stentless prosthetic aortic valves: Transcatheter versus surgical approach

Abstract

Objectives: The objective was to compare outcomes of redo-aortic valve replacement (AVR) via surgical or transcatheter approach in prior surgical AVR with large percentage of prior stentless surgical AVR.Background: With the introduction of transcatheter aortic valve replacement (TAVR), patients with increased surgical risks now have an alternative to redo surgical AVR (SAVR), known as valve-in-valve (ViV) TAVR. Stentless prosthetic aortic valves present a more challenging implantation for ViV-TAVR given the lack of structural frame. Methods:We performed a retrospective study of 173 subjects who have undergone SAVR (N = 100) or ViV-TAVR (N = 73) in patients with prior surgical AVR at Wake Forest Baptist Medical Center from 2009 to 2019. Our study received the proper ethical oversight. Results:The average ages in redo-SAVR and ViV-TAVR groups were 58.03 ± 13.86 and 66.57 ± 13.44 years, respectively (p < 0.0001). The redo-SAVR had significantly lower STS (2.78 ± 2.09 and 4.68 ± 5.51, p < 0.01) and Euroscores (4.32 ± 2.98 and 7.51 ± 8.24, p < 0.05). The redo-SAVR group had higher percentage requiring mechanical support (8% vs. 0%, p < 0.05) and vasopressors (53% vs. 0%, p < 0.0001), longer length of stay (13.65 ± 11.23 vs. 5.68 ± 7.64 days, p < 0.0001), and inpatient mortality (16% vs. 2.78%, p < 0.005). At 30-day follow-up, redo-SAVR group had higher rates of acute kidney injury (10% vs. 0%, p < 0.01), however ViV-TAVR group had more new left bundle branch blocks (6.85% vs. 0%, p < 0.05). No significant differences regarding re-hospitalization rates, stroke, or death up to 1-year. Conclusion:Although the ViV-TAVR group had higher risk patients, there were significantly fewer procedural complications, shorter length of stay, and similar mortality outcomes up to 1-year follow-up.

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

“…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 with 11 studies 6 , 10 , 14 , 15 , 16 , 17 , 18 , 19 , 21 , 22 , 24 , 25 reporting on AKI outcomes postoperatively (Figure 1A ). The overall OR for AKI showed a statistically significant difference in favor of ViV‐TAVR versus redo SAVR (random‐effects model: OR: 0.45; 95% CI: 0.30–0.69; p < .001).…”

“…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 pacemaker implantation rate (Figure 2C ) demonstrated no statistically significant difference between ViV‐TAVR and redo SAVR (random‐effects model: OR: 0.65; 95% CI: 0.37–1.14; p = .13) among 15 studies. 6 , 8 , 9 , 10 , 11 , 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 22 , 23 There was evidence of high heterogeneity among studies reporting on pacemaker implantation rate.…”

“…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.…”