Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) had superior short-term outcomes than redo surgical aortic valve replacement (SAVR), but comparable long-term outcomes, according to the results of a nationwide, longitudinal cohort study published in the Journal of the American College of Cardiology.
Using France’s administrative hospital discharge database, data from (n=4327) treated for aortic bioprosthesis failure by redo SAVR or VIV TAVR between 2010 and 2019 were examined. Propensity score matching was performed to balance possible cofactors, with the final dataset including 717 patients for each treatment.
The cohorts for the preliminary propensity score matching differed significantly for demographic parameters (P <.0001) and all included comorbidities (P ≤.02), with the exception of atrial fibrillation (P =.99), obesity (P =.99), ischemic stroke (P =.76), human immunodeficiency virus infection (P =.76), liver disease (P =.64), intracranial bleeding (P =.62), diabetes (P =.60), gastrointestinal reflux (P=.39), and alcohol-related diseases (P =.26). After propensity-matching the cohorts did not differ significantly for any cofactors.
At the 30-day follow-up, patients who had undergone VIV TAVR had lower rates of new-onset atrial fibrillation (odds ratio [OR], 0.13; 95% CI, 0.05-0.38; P <.0001), cardiovascular death (OR, 0.43; 95% CI, 0.25-0.73; P =.008), major clinical events (OR, 0.62; 95% CI, 0.44-0.88; P =.03), and all-cause mortality (OR, 0.48; 95% CI, 0.30-0.78; P =.01) when compared with redo SAVR.
The long-term (median, 516-day follow-up) incidence of: cardiovascular death (incidence rate ratio [IRR], 1.04; 95% CI, 0.75-1.44; P =1.00), myocardial infarction (IRR, 1.41; 0.72-2.79; P =1.00), new-onset atrial fibrillation (IRR, 0.85; 0.59-1.21; P =1.00), and all-cause death (IRR, 1.14; 95% CI, 0.91-1.44; P =.92) were comparable for VIV TAVR vs redo SAVR.
At the 30-day follow-up, VIV TAVR vs SAVR recipients had a greater need for a permanent pacemaker (OR, 3.72; 95% CI, 2.58-5.37; P <.0001) and at the long-term follow-up, they were more likely to be admitted to the hospital due to heart failure (OR, 1.37; 95% CI, 1.10-1.71; P =.02).
A limitation of this study was that all data were from hospital administration databases, so any death or complication outside the French hospital system was not included.
“At 30 days, VIV TAVR was associated with lower rates of outcomes, whereas in the long-term, redo SAVR showed lower incidences of rehospitalization for heart failure. Those results seem to be time-dependent, with VIV TAVR being associated with better outcomes in the most recent period (from 2015 to 2019),” concluded the study authors.
Deharo P, Bisson A, Herbert J, et al. Transcatheter valve-in-valve aortic valve replacement as an alternative to surgical re-replacement. J Am Coll Cardiol. 2020;76(5):489-99.