Nikhil Nalluri1, Varunsiri Atti2, Abdullah B Munir1, Boutros Karam1, Nileshkumar J Patel3, Varun Kumar4, Praveen Vemula5, Sushruth Edla6, Deepak Asti7, Amrutha Paturu8, Sriramya Gayam9, Jonathan Spagnola1, Emad Barsoum1, Gregory A Maniatis1, Frank Tamburrino1, Ruben Kandov1, James Lafferty1, Chad Kliger7. 1. Department of Cardiology, Staten Island University Hospital, Northwell Health, Staten Island, New York City, New York. 2. Department of Internal Medicine, Michigan State University, Sparrow Hospital, East Lansing, Michigan. 3. Department of Cardiology, University of Miami, Jackson Memorial Hospital, Miami, Florida. 4. Department of Cardiology, Mount Sinai St. Luke's Roosevelt Hospital, New York City, New York. 5. Department of Internal Medicine, Sparrow Health System, Lansing, Michigan. 6. Department of Cardiology, St. John Hospital and Medical Center, Detroit, Michigan. 7. Department of Interventional Cardiology, Lenox Hill Hospital, Northwell Health, Manhattan, New York City, New York. 8. Department of Internal Medicine, NRI Medical College, Guntur, India. 9. Department of Internal Medicine, KVG Medical College, Sullia, Karnataka, India.
Abstract
BACKGROUND: Bioprosthetic (BP) valves have been increasingly used for aortic valve replacement over the last decade. Due to their limited durability, patients presenting with failed BP valves are rising. Valve in Valve - Transcatheter Aortic Valve Implantation (ViV-TAVI) emerged as an alternative to the gold standard redo-Surgical Aortic Valve Replacement (redo-SAVR). However, the utility of ViV-TAVI is poorly understood. METHODS: A systematic electronic search of the scientific literature was done in PubMed, EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov. Only studies which compared the safety and efficacy of ViV-TAVI and redo-SAVR head to head in failed BP valves were included. RESULTS: Six observational studies were eligible and included 594 patients, of whom 255 underwent ViV- TAVI and 339 underwent redo-SAVR. There was no significant difference between ViV-TAVI and redo- SAVR for procedural, 30 day and 1 year mortality rates. ViV-TAVI was associated with lower risk of permanent pacemaker implantation (PPI) (OR: 0.43, CI: 0.21-0.89; P = 0.02) and a trend toward increased risk of paravalvular leak (PVL) (OR: 5.45, CI: 0.94-31.58; P = 0.06). There was no significant difference for stroke, major bleeding, vascular complications and postprocedural aortic valvular gradients more than 20 mm-hg. CONCLUSION: Our results reiterate the safety and feasibility of ViV-TAVI for failed aortic BP valves in patients deemed to be at high risk for surgery. VIV-TAVI was associated with lower risk of permanent pacemaker implantation with a trend toward increased risk of paravalvular leak.
BACKGROUND: Bioprosthetic (BP) valves have been increasingly used for aortic valve replacement over the last decade. Due to their limited durability, patients presenting with failed BP valves are rising. Valve in Valve - Transcatheter Aortic Valve Implantation (ViV-TAVI) emerged as an alternative to the gold standard redo-Surgical Aortic Valve Replacement (redo-SAVR). However, the utility of ViV-TAVI is poorly understood. METHODS: A systematic electronic search of the scientific literature was done in PubMed, EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov. Only studies which compared the safety and efficacy of ViV-TAVI and redo-SAVR head to head in failed BP valves were included. RESULTS: Six observational studies were eligible and included 594 patients, of whom 255 underwent ViV- TAVI and 339 underwent redo-SAVR. There was no significant difference between ViV-TAVI and redo- SAVR for procedural, 30 day and 1 year mortality rates. ViV-TAVI was associated with lower risk of permanent pacemaker implantation (PPI) (OR: 0.43, CI: 0.21-0.89; P = 0.02) and a trend toward increased risk of paravalvular leak (PVL) (OR: 5.45, CI: 0.94-31.58; P = 0.06). There was no significant difference for stroke, major bleeding, vascular complications and postprocedural aortic valvular gradients more than 20 mm-hg. CONCLUSION: Our results reiterate the safety and feasibility of ViV-TAVI for failed aortic BP valves in patients deemed to be at high risk for surgery. VIV-TAVI was associated with lower risk of permanent pacemaker implantation with a trend toward increased risk of paravalvular leak.
Authors: Iuliana Coti; Udo Maierhofer; Claus Rath; Paul Werner; Christian Loewe; Alfred Kocher; Guenther Laufer; Martin Andreas Journal: Interact Cardiovasc Thorac Surg Date: 2021-01-22
Authors: Sascha Macherey; Max Meertens; Victor Mauri; Christian Frerker; Matti Adam; Stephan Baldus; Tobias Schmidt Journal: J Am Heart Assoc Date: 2021-03-08 Impact factor: 5.501