AIMS: We sought to perform a head-to-head comparison of contemporary 30-day outcomes and readmissions between valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) patients and a matched cohort of high-risk reoperative surgical aortic valve replacement (re-SAVR) patients using a large, multicentre, national database. METHODS AND RESULTS: We utilized the nationally weighted 2012-16 National Readmission Database claims to identify all US adult patients with degenerated bioprosthetic aortic valves who underwent either VIV-TAVR (n = 3443) or isolated re-SAVR (n = 3372). Thirty-day outcomes were compared using multivariate analysis and propensity score matching (1:1). Unadjusted, VIV-TAVR patients had significantly lower 30-day mortality (2.7% vs. 5.0%), 30-day morbidity (66.4% vs. 79%), and rates of major bleeding (35.8% vs. 50%). On multivariable analysis, re-SAVR was a significant risk factor for both 30-day mortality [adjusted odds ratio (aOR) of VIV-SAVR (vs. re-SAVR) 0.48, 95% confidence interval (CI) 0.28-0.81] and 30-day morbidity [aOR for VIV-TAVR (vs. re-SAVR) 0.54, 95% CI 0.43-0.68]. After matching (n = 2181 matched pairs), VIV-TAVR was associated with lower odds of 30-day mortality (OR 0.41, 95% CI 0.23-0.74), 30-day morbidity (OR 0.53, 95% CI 0.43-0.72), and major bleeding (OR 0.66, 95% CI 0.51-0.85). Valve-in-valve TAVR was also associated with shorter length of stay (median savings of 2 days, 95% CI 1.3-2.7) and higher odds of routine home discharges (OR 2.11, 95% CI 1.61-2.78) compared to re-SAVR. CONCLUSION: In this large, nationwide study of matched high-risk patients with degenerated bioprosthetic aortic valves, VIV-TAVR appears to confer an advantage over re-SAVR in terms of 30-day mortality, morbidity, and bleeding complications. Further studies are warranted to benchmark in low- and intermediate-risk patients and to adequately assess longer-term efficacy. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: We sought to perform a head-to-head comparison of contemporary 30-day outcomes and readmissions between valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) patients and a matched cohort of high-risk reoperative surgical aortic valve replacement (re-SAVR) patients using a large, multicentre, national database. METHODS AND RESULTS: We utilized the nationally weighted 2012-16 National Readmission Database claims to identify all US adult patients with degenerated bioprosthetic aortic valves who underwent either VIV-TAVR (n = 3443) or isolated re-SAVR (n = 3372). Thirty-day outcomes were compared using multivariate analysis and propensity score matching (1:1). Unadjusted, VIV-TAVR patients had significantly lower 30-day mortality (2.7% vs. 5.0%), 30-day morbidity (66.4% vs. 79%), and rates of major bleeding (35.8% vs. 50%). On multivariable analysis, re-SAVR was a significant risk factor for both 30-day mortality [adjusted odds ratio (aOR) of VIV-SAVR (vs. re-SAVR) 0.48, 95% confidence interval (CI) 0.28-0.81] and 30-day morbidity [aOR for VIV-TAVR (vs. re-SAVR) 0.54, 95% CI 0.43-0.68]. After matching (n = 2181 matched pairs), VIV-TAVR was associated with lower odds of 30-day mortality (OR 0.41, 95% CI 0.23-0.74), 30-day morbidity (OR 0.53, 95% CI 0.43-0.72), and major bleeding (OR 0.66, 95% CI 0.51-0.85). Valve-in-valve TAVR was also associated with shorter length of stay (median savings of 2 days, 95% CI 1.3-2.7) and higher odds of routine home discharges (OR 2.11, 95% CI 1.61-2.78) compared to re-SAVR. CONCLUSION: In this large, nationwide study of matched high-risk patients with degenerated bioprosthetic aortic valves, VIV-TAVR appears to confer an advantage over re-SAVR in terms of 30-day mortality, morbidity, and bleeding complications. Further studies are warranted to benchmark in low- and intermediate-risk patients and to adequately assess longer-term efficacy. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Joseph E Bavaria; Carl L Tommaso; Ralph G Brindis; John D Carroll; G Michael Deeb; Ted E Feldman; Thomas G Gleason; Eric M Horlick; Clifford J Kavinsky; Dharam J Kumbhani; D Craig Miller; A Allen Seals; David M Shahian; Richard J Shemin; Thoralf M Sundt; Vinod H Thourani Journal: J Am Coll Cardiol Date: 2018-07-18 Impact factor: 24.094
Authors: Michael J Mack; Martin B Leon; Vinod H Thourani; Raj Makkar; Susheel K Kodali; Mark Russo; Samir R Kapadia; S Chris Malaisrie; David J Cohen; Philippe Pibarot; Jonathon Leipsic; Rebecca T Hahn; Philipp Blanke; Mathew R Williams; James M McCabe; David L Brown; Vasilis Babaliaros; Scott Goldman; Wilson Y Szeto; Philippe Genereux; Ashish Pershad; Stuart J Pocock; Maria C Alu; John G Webb; Craig R Smith Journal: N Engl J Med Date: 2019-03-16 Impact factor: 91.245
Authors: Danny Dvir; John Webb; Stephen Brecker; Sabine Bleiziffer; David Hildick-Smith; Antonio Colombo; Fleur Descoutures; Christian Hengstenberg; Neil E Moat; Raffi Bekeredjian; Massimo Napodano; Luca Testa; Thierry Lefevre; Victor Guetta; Henrik Nissen; José-María Hernández; David Roy; Rui C Teles; Amit Segev; Nicolas Dumonteil; Claudia Fiorina; Michael Gotzmann; Didier Tchetche; Mohamed Abdel-Wahab; Federico De Marco; Andreas Baumbach; Jean-Claude Laborde; Ran Kornowski Journal: Circulation Date: 2012-10-10 Impact factor: 29.690
Authors: Jaffar M Khan; Adam B Greenbaum; Vasilis C Babaliaros; Toby Rogers; Marvin H Eng; Gaetano Paone; Bradley G Leshnower; Mark Reisman; Lowell Satler; Ron Waksman; Marcus Y Chen; Annette M Stine; Xin Tian; Danny Dvir; Robert J Lederman Journal: JACC Cardiovasc Interv Date: 2019-06-12 Impact factor: 11.195
Authors: Helmut Baumgartner; Volkmar Falk; Jeroen J Bax; Michele De Bonis; Christian Hamm; Per Johan Holm; Bernard Iung; Patrizio Lancellotti; Emmanuel Lansac; Daniel Rodriguez Muñoz; Raphael Rosenhek; Johan Sjögren; Pilar Tornos Mas; Alec Vahanian; Thomas Walther; Olaf Wendler; Stephan Windecker; Jose Luis Zamorano Journal: Eur Heart J Date: 2017-09-21 Impact factor: 29.983
Authors: John G Webb; Dale J Murdoch; Maria C Alu; Anson Cheung; Aaron Crowley; Danny Dvir; Howard C Herrmann; Susheel K Kodali; Jonathon Leipsic; D Craig Miller; Philippe Pibarot; Rakesh M Suri; David Wood; Martin B Leon; Michael J Mack Journal: J Am Coll Cardiol Date: 2019-06-04 Impact factor: 24.094
Authors: Julius I Ejiofor; Maroun Yammine; Morgan T Harloff; Siobhan McGurk; Jochen D Muehlschlegel; Prem S Shekar; Lawrence H Cohn; Pinak Shah; Tsuyoshi Kaneko Journal: Ann Thorac Surg Date: 2016-08-23 Impact factor: 4.330
Authors: Luis Augusto P Dallan; John K Forrest; Michael J Reardon; Wilson Y Szeto; Isaac George; Susheel Kodali; Neal S Kleiman; Steven J Yakubov; Kendra J Grubb; Fang Liu; Cristian Baeza; Guilherme F Attizzani Journal: J Am Heart Assoc Date: 2021-09-13 Impact factor: 5.501
Authors: Andrea Buono; Diego Maffeo; Giovanni Troise; Francesco Donatelli; Maurizio Tespili; Alfonso Ielasi Journal: J Clin Med Date: 2022-01-11 Impact factor: 4.241