Redo Surgical Aortic Valve Replacement After Prior Transcatheter Versus Surgical Aortic Valve Replacement

被引：34

作者：

Hawkins, Robert B. ^{[1
,2
]}

Deeb, G. Michael ^{[1
,2
]}

Sukul, Devraj ^{[1
,2
]}

Patel, Himanshu J. ^{[1
,2
]}

Gualano, Sarah K. ^{[1
,2
]}

Chetcuti, Stanley J. ^{[1
,2
]}

Grossman, P. Michael ^{[1
,2
]}

Ailawadi, Gorav ^{[1
,2
]}

Fukuhara, Shinichi ^{[1
,2
,3
]}

机构：

[1] Univ Michigan, Dept Cardiac Surg, Ann Arbor, MI USA

[2] Univ Michigan, Div Cardiovasc Med, Ann Arbor, MI USA

[3] Univ Michigan, 1500 East Med Ctr Dr, Ann Arbor, MI 48109 USA

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2023年 / 16卷 / 08期

关键词：

aortic stenosis; reoperation; Society of Thoracic Surgeons Adult Cardiac Surgery Database; surgical aortic valve replacement; transcatheter aortic valve replacement; OUTCOMES; REGURGITATION; STENOSIS; TAVR;

D O I：

10.1016/j.jcin.2023.03.015

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Aortic stenosis treatment should consider risks and benefits for lifetime management. Although the feasibility of redo transcatheter aortic valve replacement (TAVR) remains unclear, concerns are emerging regarding reoperation after TAVR.OBJECTIVES The authors sought to define comparative risk of surgical aortic valve replacement (SAVR) after prior TAVR or SAVR.METHODS Data on patients undergoing bioprosthetic SAVR after TAVR and/or SAVR were extracted from the Society of Thoracic Surgeons Database (2011-2021). Overall and isolated SAVR cohorts were analyzed. The primary outcome was operative mortality. Risk adjustment using hierarchical logistic regression as well as propensity score matching for iso-lated SAVR cases were performed.RESULTS Of 31,106 SAVR patients, 1,126 had prior TAVR (TAVR-SAVR), 674 had prior SAVR and TAVR (SAVR-TAVR-SAVR), and 29,306 had prior SAVR (SAVR-SAVR). Yearly rates of TAVR-SAVR and SAVR-TAVR-SAVR increased over time, whereas SAVR-SAVR was stable. The TAVR-SAVR patients were older, with higher acuity, and with greater comorbidities than other cohorts. The unadjusted operative mortality was highest in the TAVR-SAVR group (17% vs 12% vs 9%, respectively; P < 0.001). Compared with SAVR-SAVR, risk-adjusted operative mortality was significantly higher for TAVR-SAVR (OR: 1.53; P = 0.004), but not SAVR-TAVR-SAVR (OR: 1.02; P = 0.927). After propensity score matching, operative mortality of isolated SAVR was 1.74 times higher for TAVR-SAVR than SAVR-SAVR patients (P = 0.020).CONCLUSIONS The number of post-TAVR reoperations is increasing and represent a high-risk population. Yet even in isolated SAVR cases, SAVR after TAVR is independently associated with increased risk of mortality. Patients with life expectancy beyond a TAVR valve and unsuitable anatomy for redo-TAVR should consider a SAVR-first approach. (J Am Coll Cardiol Intv 2023;16:942-953)(c) 2023 by the American College of Cardiology Foundation.

引用

页码：942 / 953

页数：12

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