Valve-in-Valve vs Re-Surgical Aortic Valve Replacement for Reducing Short-Term Mortality

Short term mortality rates were lower among patients with degenerated surgical bioprostheses who received valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) compared with re-surgical aortic valve replacement (re-SAVR). These findings were published in Catheterization & Cardiovascular Interventions.

This systematic review and meta-analysis was conducted by investigators at the University of Turin in Italy. Publication databases were searched through December 2020 for studies of ViV TAVI replacement or re-SAVR. A total of 11 studies published between 2015 and 2020 with propensity-matched (n=6) or observational cohort (n=5) designs were included in this analysis.

The study population comprised 4224 patients undergoing ViV TAVI and 4346 undergoing re-SAVR. The ViV TAVI and re-SAVR cohorts were aged median 76 (IQR, 72.5-79) and 71.5 (IQR, 58-77.4) years; 60.2% and 61.3% were men; 72.1% and 65.6% had heart failure; 42.7% and 35% had atrial fibrillation; 82.7% and 77.8% had hypertension; and 11.5% and 10.5% had previous myocardial infarction, respectively.

All-cause mortality (odds ratio [OR], 0.43; 95% CI, 0.29-0.64) and cardiovascular mortality (OR, 0.44; 95% CI, 0.26-0.73) were significantly lower among the ViV TAVR recipients. At the midterm follow-up (mean, 717 days) however, no group differences were observed for all-cause (OR, 1.04; 95% CI, 0.87-1.25) or cardiovascular (OR, 1.05; 95% CI, 0.78-1.43) mortality.

ViV TAVR was favored for reducing major bleeding events (OR, 0.41; 95% CI, 0.25-0.67), new-onset atrial fibrillation (OR, 0.23; 95% CI, 0.12-0.42), and length of hospital stay (mean difference, -3.69; 95% CI, -5 to -2.38 days). Neither group was favored for reducing 30-day stroke, major vascular complications, or permanent pacemaker implantation.

No significant trends were observed in subgroup analyses.

The major limitation of this study was the lack of long-term data.

“In patients with a degenerated aortic bioprosthesis, ViV TAVI is associated with better short‐term outcomes, including all‐cause mortality, without any difference in mortality at midterm follow‐up compared with surgical redo,” the study authors wrote. “The satisfactory long‐term results of ViV may contribute to expand the indication of bioprosthetic valve to mid‐aged patients avoiding mechanical prosthesis and thus life‐long anticoagulation, although longer follow‐up and larger cohorts are required to further investigate the long‐term durability of TAVI prostheses also in ViV procedures.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Bruno F, Elia E, D’Ascenzo F, et al. Valve‐in‐valve transcatheter aortic valve replacement or re‐surgical aortic valve replacement in degenerated bioprostheses: A systematic review and meta‐analysis of short and midterm results. Catheter Cardiovasc Interv. Published online April 29, 2022. doi:10.1002/ccd.30219