Structural Heart (Nov 2022)

Hemodynamic and Clinical Outcomes in Redo-Surgical Aortic Valve Replacement vs. Transcatheter Valve-in-Valve

  • 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

Journal volume & issue
Vol. 6, no. 6
p. 100106

Abstract

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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.

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