Valve-in-Valve TAVR versus Redo Surgical Aortic Valve Replacement: Early Outcomes

Abstract

Objective This study aimed to assess short-term outcomes of patients with failed aortic valve bioprosthesis undergoing valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) or redo surgical aortic valve replacement (rSAVR).

Methods Between 2009 and 2019, 90 patients who underwent ViV-TAVR (n = 73) or rSAVR (n = 17) due to failed aortic valve bioprosthesis fulfilled the inclusion criteria. Groups were compared regarding clinical end points, including in-hospital all-cause mortality. Patients with endocarditis and in a need of combined cardiac surgery were excluded from the study.

Results ViV-TAVR patients were older (78.0 ± 7.4 vs. 62.1 ± 16.2 years, p = 0.012) and showed a higher prevalence of baseline comorbidities such as atrial fibrillation, diabetes mellitus, hyperlipidemia, and arterial hypertension. In-hospital all-cause mortality was higher for rSAVR than in the ViV-TAVR group (17.6 vs. 0%, p < 0.001), whereas intensive care unit stay was more often complicated by blood transfusions for rSAVR patients without differences in cerebrovascular events. The paravalvular leak was detected in 52.1% ViV-TAVR patients compared with 0% among rSAVR patients (p < 0.001).

Conclusion ViV-TAVR can be a safe and feasible alternative treatment option in patients with degenerated aortic valve bioprosthesis. The choice of treatment should include the patient's individual characteristics considering ViV-TAVR as a standard of care.

Keywords

valve-in-valve - redo surgery - deteriorated aortic valve bioprosthesis - cardiac surgery - early outcomes

Authors' Contribution

Since our author list overcomes the limit of seven authors per manuscript, we would like to elaborate on the individual authors' contribution. A.C. and E.K. have contributed equally to the writing of the manuscript. K.E., C.W., and V.M. did the literature search as well as data extraction. P.B.R. and M.A. made the statistical interpretation of data. T.R., S.B., and T.W. were responsible for the critical revision of the manuscript.

^* Both authors contributed equally to the work.

Publication History

Received: 04 December 2020

Accepted: 27 May 2021

Article published online:
14 September 2021

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