Michel Pompeu B O Sá1, Jef Van den Eynde2, Matheus Simonato3, Luiz Rafael P Cavalcanti4, Ilias P Doulamis5, Viktoria Weixler6, Polydoros N Kampaktsis7, Michele Gallo8, Pietro L Laforgia9, Konstantin Zhigalov10, Arjang Ruhparwar10, Alexander Weymann10, Philippe Pibarot11, Marie-Annick Clavel11. 1. Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco-PROCAPE, University of Pernambuco-UPE, Recife, Brazil. Electronic address: michel_pompeu@yahoo.com.br. 2. Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium. 3. Division of Cardiac Surgery, Escola Paulista de Medicina-UNIFESP, São Paulo, Brazil. 4. Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco-PROCAPE, University of Pernambuco-UPE, Recife, Brazil. 5. Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA. 6. German Heart Center, Berlin, Germany. 7. NYU Langone Medical Center, New York, New York, USA. 8. Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland. 9. I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy. 10. Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany. 11. Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada.
Abstract
OBJECTIVES: The aim of this study was to evaluate early results of valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) versus redo surgical aortic valve replacement (SAVR) for structural valve degeneration (SVD). BACKGROUND: ViV TAVR has been increasingly used for SVD, but it remains unknown whether it produces better or at least comparable results as redo SAVR. METHODS: Observational studies comparing ViV TAVR and redo SAVR were identified in a systematic search of published research. Random-effects meta-analysis was performed, comparing clinical outcomes between the 2 groups. RESULTS: Twelve publications including a total of 16,207 patients (ViV TAVR, n = 8,048; redo SAVR, n = 8,159) were included from studies published from 2015 to 2020. In the pooled analysis, ViV TAVR was associated with lower rates of 30-day mortality overall (odds ratio [OR]: 0.53; 95% confidence interval [CI]: 0.32 to 0.87; p = 0.017) and for matched populations (OR: 0.419; 95% CI: 0.278 to 0.632; p = 0.003), stroke (OR: 0.65; 95% CI: 0.55 to 0.76; p < 0.001), permanent pacemaker implantation (OR: 0.73; 95% CI: 0.22 to 2.43; p = 0.536), and major bleeding (OR: 0.49; 95% CI: 0.26 to 0.93; p = 0.034), as well as with shorter hospital stay (OR: -3.30; 95% CI: -4.52 to -2.08; p < 0.001). In contrast, ViV TAVR was associated with higher rates of myocardial infarction (OR: 1.50; 95% CI: 1.01 to 2.23; p = 0.045) and severe patient-prosthesis mismatch (OR: 4.63; 95% CI: 3.05 to 7.03; p < 0.001). The search revealed an important lack of comparative studies with long-term results. CONCLUSIONS: ViV TAVR is a valuable option in the treatment of patients with SVD because of its lower incidence of post-operative complications and better early survival compared with redo SAVR. However, ViV TAVR is associated with higher rates of myocardial infarction and severe patient-prosthesis mismatch.
OBJECTIVES: The aim of this study was to evaluate early results of valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) versus redo surgical aortic valve replacement (SAVR) for structural valve degeneration (SVD). BACKGROUND: ViV TAVR has been increasingly used for SVD, but it remains unknown whether it produces better or at least comparable results as redo SAVR. METHODS: Observational studies comparing ViV TAVR and redo SAVR were identified in a systematic search of published research. Random-effects meta-analysis was performed, comparing clinical outcomes between the 2 groups. RESULTS: Twelve publications including a total of 16,207 patients (ViV TAVR, n = 8,048; redo SAVR, n = 8,159) were included from studies published from 2015 to 2020. In the pooled analysis, ViV TAVR was associated with lower rates of 30-day mortality overall (odds ratio [OR]: 0.53; 95% confidence interval [CI]: 0.32 to 0.87; p = 0.017) and for matched populations (OR: 0.419; 95% CI: 0.278 to 0.632; p = 0.003), stroke (OR: 0.65; 95% CI: 0.55 to 0.76; p < 0.001), permanent pacemaker implantation (OR: 0.73; 95% CI: 0.22 to 2.43; p = 0.536), and major bleeding (OR: 0.49; 95% CI: 0.26 to 0.93; p = 0.034), as well as with shorter hospital stay (OR: -3.30; 95% CI: -4.52 to -2.08; p < 0.001). In contrast, ViV TAVR was associated with higher rates of myocardial infarction (OR: 1.50; 95% CI: 1.01 to 2.23; p = 0.045) and severe patient-prosthesis mismatch (OR: 4.63; 95% CI: 3.05 to 7.03; p < 0.001). The search revealed an important lack of comparative studies with long-term results. CONCLUSIONS: ViV TAVR is a valuable option in the treatment of patients with SVD because of its lower incidence of post-operative complications and better early survival compared with redo SAVR. However, ViV TAVR is associated with higher rates of myocardial infarction and severe patient-prosthesis mismatch.
Authors: Luca Testa; Matteo Casenghi; Enrico Criscione; Nicolas M Van Mieghem; Didier Tchétché; Anita W Asgar; Ole De Backer; Azeem Latib; Bernhard Reimers; Giulio Stefanini; Carlo Trani; Francesco Giannini; Antonio Bartorelli; Wojtek Wojakowski; Maciej Dabrowski; Dariusz Jagielak; Adrian P Banning; Rajesh Kharbanda; Raul Moreno; Joachim Schofer; Christina Brinkmann; Niels van Royen; Duane Pinto; Antoni Serra; Amit Segev; Arturo Giordano; Nedy Brambilla; Mauro Agnifili; Antonio Popolo Rubbio; Mattia Squillace; Jacopo Oreglia; Rudolph Tanja; James M McCabe; Alexander Abizaid; Michiel Voskuil; Rui Teles; Giuseppe Biondi Zoccai; Lars Sondergaard; Francesco Bedogni Journal: Front Cardiovasc Med Date: 2022-07-29
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