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

被引：6

作者：

Hecht, Sebastien ^{[1
]}

Zenses, Anne-Sophie ^{[1
]}

Bernard, Jeremy ^{[1
]}

Tastet, Lionel ^{[1
]}

Cote, Nancy ^{[1
]}

Guimaraes, Leonardo de Freitas Campos ^{[1
]}

Paradis, Jean-Michel ^{[1
]}

Beaudoin, Jonathan ^{[1
]}

O'Connor, Kim ^{[1
]}

Bernier, Mathieu ^{[1
]}

Dumont, Eric ^{[1
]}

Kalavrouziotis, Dimitri ^{[1
]}

Delarochelliere, Robert ^{[1
]}

Mohammadi, Siamak ^{[1
]}

Clavel, Marie-Annick ^{[1
]}

Rodes-Cabau, Josep ^{[1
]}

Salaun, Erwan ^{[1
]}

Pibarot, Philippe ^{[1
]}

机构：

[1] Laval Univ, Inst Univ Cardiol & Pneumol Quebec, Quebec Heart & Lung Inst, Univ Laval, Quebec City, PQ, Canada

来源：

STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM | 2022年 / 6卷 / 06期

基金：

加拿大健康研究院;

关键词：

Aortic bioprosthesis; Redo; -surgery; Structural valve deterioration; Transcatheter valve -in -valve; PROSTHESIS-PATIENT MISMATCH; END-POINT DEFINITIONS; EUROPEAN ASSOCIATION; AMERICAN SOCIETY; IMPLANTATION; ECHOCARDIOGRAPHY; RECOMMENDATIONS; MANAGEMENT; TRIAL;

D O I：

10.1016/j.shj.2022.100106

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页数：9