Hemodynamic and Clinical Outcomes in Redo-Surgical Aortic Valve Replacement vs. Transcatheter Valve-in-Valve

Sébastien Hecht; Anne-Sophie Zenses; Jérémy Bernard; Lionel Tastet; Nancy Côté; Leonardo de Freitas Campos Guimarães; Jean-Michel Paradis; Jonathan Beaudoin; Kim O'Connor; Mathieu Bernier; Eric Dumont; Dimitri Kalavrouziotis; Robert Delarochellière; Siamak Mohammadi; Marie-Annick Clavel; Josep Rodés-Cabau; Erwan Salaun; Philippe Pibarot

doi:10.1016/j.shj.2022.100106

Hemodynamic and Clinical Outcomes in Redo-Surgical Aortic Valve Replacement vs. Transcatheter Valve-in-Valve

Struct Heart. 2022 Oct 28;6(6):100106. doi: 10.1016/j.shj.2022.100106. eCollection 2022 Nov.

Authors

Sébastien Hecht¹, Anne-Sophie Zenses¹, Jérémy Bernard¹, Lionel Tastet¹, Nancy Côté¹, Leonardo de Freitas Campos Guimarães¹, Jean-Michel Paradis¹, Jonathan Beaudoin¹, Kim O'Connor¹, Mathieu Bernier¹, Eric Dumont¹, Dimitri Kalavrouziotis¹, Robert Delarochellière¹, Siamak Mohammadi¹, Marie-Annick Clavel¹, Josep Rodés-Cabau¹, Erwan Salaun¹, Philippe Pibarot¹

Affiliation

¹ Institut universitaire de cardiologie et de pneumologie de Québec/Québec Heart & Lung Institute, Universite Laval / Laval University, Québec City, Québec, Canada.

Abstract

Background: Transcatheter valve-in-valve replacement (ViV-TAVR) has emerged as an alternative to redo-surgical aortic valve replacement (Redo-SAVR) for the treatment of failed surgical aortic bioprostheses. However, the benefit of ViV-TAVR compared with Redo-SAVR remains debated with regard to short-term hemodynamic results and short- and long-term clinical outcomes.

Objective: This study aimed to compare short-term hemodynamic performance and long-term clinical outcomes of ViV-TAVR vs. Redo-SAVR in patients treated for surgical aortic bioprosthetic valve failure.

Methods: We retrospectively analyzed the data prospectively collected in 184 patients who underwent Redo-SAVR or ViV-TAVR. Transthoracic echocardiography was performed before and after the procedure and analyzed in an echocardiography core laboratory using the new Valve Academic Research Consortium-3 criteria. An inverse probability of treatment weighting was used to compare the outcomes between both procedures.

Results: ViV-TAVR showed lower rate of intended hemodynamic performance (39.2% vs. 67.7%, p < 0.001) at 30 days, which was essentially driven by a higher rate (56.2% vs. 28.8%, p = 0.001) of high residual gradient (mean transvalvular gradient ≥20 mm Hg). Despite a trend for higher 30-day mortality in the Redo-SAVR vs. ViV-TAVR group (8.7% vs. 2.5%, odds ratio [95% CI]: 3.70 [0.77-17.6]; p = 0.10), the long-term mortality was significantly lower (24.2% vs. 50.1% at 8 years; hazard ratio [95% CI]: 0.48 [0.26-0.91]; p = 0.03) in the Redo-SAVR group. After inverse probability of treatment weighting analysis, Redo-SAVR remained significantly associated with reduced long-term mortality compared with ViV-TAVR (hazard ratio [95% CI]: 0.32 [0.22-0.46]; p < 0.001).

Conclusions: ViV-TAVR was associated with a lower rate of intended hemodynamic performance and numerically lower mortality at 30 days but higher rates of long-term mortality compared with Redo-SAVR.

Keywords: Aortic bioprosthesis; Redo-surgery; Structural valve deterioration; Transcatheter valve-in-valve.