Valve-in-valve transcatheter aortic valve implantation versus repeat surgical aortic valve replacement in patients with a failed aortic bioprosthesis

Majmundar, Monil; Doshi, Rajkumar; Kumar, Ashish; Johnston, Douglas R.; Brockett, James; Kanaa’N, Anmar; Lahorra, Joseph A.; Svensson, Lars; Krishnaswamy, Amar; Reed, Grant W.; Puri, Rishi; Kapadia, Samir; Kalra, Ankur

doi:10.4244/eij-d-21-00472

Cited by 25 publications

(26 citation statements)

References 27 publications

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“…These methods were used in cardiovascular medicine previously. 24 , 25 We performed sensitivity analysis by performing inverse probability of treatment weighting (IPTW) to evaluate postdischarge mortality.…”

Section: Methodsmentioning

confidence: 99%

Invasive Versus Medical Management in Patients With Chronic Kidney Disease and Non–ST‐Segment–Elevation Myocardial Infarction

Majmundar

Ibarra

Kumar

et al. 2022

JAHA

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Background The role of invasive management compared with medical management in patients with non–ST‐segment–elevation myocardial infarction (NSTEMI) and advanced chronic kidney disease (CKD) is uncertain, given the increased risk of procedural complications in patients with CKD. We aimed to compare clinical outcomes of invasive management with medical management in patients with NSTEMI‐CKD. Methods and Results We identified NSTEMI and CKD stages 3, 4, 5, and end‐stage renal disease admissions using International Classification of Diseases, Tenth Revision, Clinical Modification ( ICD‐10‐CM ) codes from the Nationwide Readmission Database 2016 to 2018. Patients were stratified into invasive and medical management. Primary outcome was mortality (in‐hospital and 6 months after discharge). Secondary outcomes were in‐hospital postprocedural complications (acute kidney injury requiring dialysis, major bleeding) and postdischarge 6‐month safety and major adverse cardiovascular events. Out of 141 052 patients with NSTEMI‐CKD, 85 875 (60.9%) were treated with invasive management, whereas 55 177 (39.1%) patients were managed medically. In propensity‐score matched cohorts, invasive strategy was associated with lower in‐hospital (CKD 3: odds ratio [OR], 0.47 [95% CI, 0.43–0.51]; P <0.001; CKD 4: OR, 0.79 [95% CI, 0.69–0.89]; P <0.001; CKD 5: OR, 0.72 [95% CI, 0.49–1.06]; P =0.096; end‐stage renal disease: OR, 0.51 [95% CI, 0.46–0.56]; P <0.001) and 6‐month mortality. Invasive management was associated with higher in‐hospital postprocedural complications but no difference in postdischarge safety outcomes. Invasive management was associated with a lower hazard of major adverse cardiovascular events at 6 months in all CKD groups compared with medical management. Conclusions Invasive management was associated with lower mortality and major adverse cardiovascular events but minimal increased in‐hospital complications in patients with NSTEMI‐CKD compared with medical management, suggesting patients with NSTEMI‐CKD should be offered invasive management.

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Section: Methodsmentioning

confidence: 99%

Invasive Versus Medical Management in Patients With Chronic Kidney Disease and Non–ST‐Segment–Elevation Myocardial Infarction

Majmundar

Ibarra

Kumar

et al. 2022

JAHA

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“…Deharo et al 23 analyzed the data of 1434 patients from the French National Database and found similar results with regard to stroke outcomes. Likewise, Majmudar et al 6 in their analysis of 6769 procedures, demonstrated both stroke and pacemaker implantation rate to be comparable between redo SAVR and ViV-TAVR.…”

Section: The Implications Of Aki On Healthcare Systems and Costsmentioning

confidence: 93%

“…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).…”

Section: Operative Mortality and 30-day Mortalitymentioning

confidence: 97%

“…Complications in ViV-TAVR versus redo SAVRWhen the study by Majmundar et al6 was excluded in the sensitivity analysis, ViV-TARV was shown to lead to less episodes of postoperative major bleeding events. Similar to the results of our sensitivity analysis, major trials assessing TAVR versus SAVR have demonstrated that surgery was associated with increased episodes of major bleeding when compared to TAVR.…”

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confidence: 99%

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

Rad

Naruka

Vardanyan

et al. 2022

Journal of Cardiac Surgery

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Introduction Postoperative acute kidney injury (AKI) and the requirement for renal replacement therapy (RRT) remain common and significant complications of both transcatheter valve‐in‐valve aortic valve replacement (ViV‐TAVR) and redo surgical aortic valve replacement (SAVR). Nevertheless, the understanding of renal outcomes in the population undergoing either redo SAVR or ViV‐TAVR remains controversial. Methods A systematic database search with meta‐analysis was conducted of comparative original articles of ViV‐TAVR versus redo SAVR in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to September 2021. Primary outcomes were AKI and RRT. Secondary outcomes were stroke, major bleeding, pacemaker implantation rate, operative mortality, and 30‐day mortality. Results Our search yielded 5435 relevant studies. Eighteen studies met the inclusion criteria with a total of 11,198 patients. We found ViV‐TAVR to be associated with lower rates of AKI, postoperative RRT, major bleeding, pacemaker implantation, operative mortality, and 30‐day mortality. No significant difference was observed in terms of stroke rate. The mean incidence of AKI in ViV‐TAVR was 6.95% (±6%) and in redo SAVR was 15.2% (±9.6%). For RRT, our data showed that VIV‐TAVR to be 1.48% (±1.46%) and redo SAVR to be 8.54% (±8.06%). Conclusion Renoprotective strategies should be put into place to prevent and reduce AKI incidence regardless of the treatment modality. Patients undergoing re‐intervention for the aortic valve constitute a high‐risk and frail population in which ViV‐TAVR demonstrated it might be a feasible option for carefully selected patients. Long‐term follow‐up data and randomized control trials will be needed to evaluate mortality and morbidity outcomes between these 2 treatments.

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“…The first Valve in Valve (VIV) procedure was performed in 2007 in Germany ( 12 ), for severe aortic regurgitation in degenerated prosthesis, and actually transcatheter VIV-TAVI is considered an option for treating failed bioprosthesis in patients with increased surgical risk ( 13 , 14 ). Recently a large USA retrospective study, enrolled 6.769 procedures, has demonstrated that VIV-TAVI was associated to lower in-hospital mortality but higher all-cause readmission at 30-day and at 6-month follow up compared to repeat surgical aortic valve replacement (SAVR) ( 15 ). However, no randomized trials have investigated the best treatment for failed surgically bioprosthetic valves comparing redo SAVR and VIV-TAVI.…”

Section: Introductionmentioning

confidence: 99%

Transcatether Aortic Valve Implantation to Treat Degenerated Surgical Bioprosthesis: Focus on the Specific Procedural Challenges

Aurigemma

Burzotta

Vergallo

et al. 2022

Front. Cardiovasc. Med.

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Actually transcatheter aortic valve implantation within failed surgically bioprosthetic valves (VIV-TAVI) is an established procedure in patients at high risk for repeat surgical aortic valve intervention. Although less invasive than surgical reintervention, VIV-TAVI procedure offers potential challenges, such as higher rates of prosthesis-patient mismatch and coronary obstruction. Thus, optimal procedural planning plays an important role to minimize the risk of procedure complications. In this review, we describe the key points of a VIV-TAVI procedure to optimize outcomes and reduce the risk of procedure complications.

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Valve-in-valve transcatheter aortic valve implantation versus repeat surgical aortic valve replacement in patients with a failed aortic bioprosthesis

Cited by 25 publications

References 27 publications

Invasive Versus Medical Management in Patients With Chronic Kidney Disease and Non–ST‐Segment–Elevation Myocardial Infarction

Invasive Versus Medical Management in Patients With Chronic Kidney Disease and Non–ST‐Segment–Elevation Myocardial Infarction

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

Transcatether Aortic Valve Implantation to Treat Degenerated Surgical Bioprosthesis: Focus on the Specific Procedural Challenges

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