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Transcatheter Replacement of Transcatheter Versus Surgically Implanted Aortic Valve Bioprostheses

2021; Elsevier BV; Volume: 77; Issue: 1 Linguagem: Inglês

10.1016/j.jacc.2020.10.053

1558-3597

Uri Landes, Janarthanan Sathananthan, Guy Witberg, Ole De Backer, Lars Søndergaard, Mohamed Abdel‐Wahab, David Holzhey, Won‐Keun Kim, Christian W. Hamm, Nicola Buzzatti, Matteo Montorfano, Sebastian Ludwig, Lenard Conradi, Moritz Seiffert, Mayra Guerrero, Abdallah El Sabbagh, Josep Rodés‐Cabau, Leonardo Guimarães, Pablo Codner, Taishi Okuno, Thomas Pilgrim, Claudia Fiorina, Antonio Colombo, Antonio Mangieri, Hélène Eltchaninoff, Luis Nombela‐Franco, Maarten P. H. van Wiechen, Nicolas M. Van Mieghem, Didier Tchetchè, Wolfgang Schoels, Matthias Kullmer, Corrado Tamburino, Jan-Malte Sinning, Baravan Al‐Kassou, Gidon Perlman, Haim Danenberg, Alfonso Ielasi, Chiara Fraccaro, Giuseppe Tarantini, Federico De Marco, Simon Redwood, John Lisko, Vasilis Babaliaros, Mika Laine, Roberto Nerla, Fausto Castriota, Ariel Finkelstein, Itamar Loewenstein, Amnon Eitan, Ronen Jaffe, Philipp Ruile, Franz‐Josef Neumann, Nicolò Piazza, Hind Alosaimi, Horst Sievert, Kolja Sievert, Marco Russo, Martin Andreas, Matjaž Bunc, Azeem Latib, Rebecca Godfrey, David Hildick‐Smith, Ming-Yu A. Chuang, Philipp Blanke, Jonathon Leipsic, David A. Wood, Tamim Nazif, Susheel Kodali, Marco Barbanti, Ran Kornowski, Martin B. Leon, John G. Webb,

Aortic Disease and Treatment Approaches

Surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR) are now both used to treat aortic stenosis in patients in whom life expectancy may exceed valve durability. The choice of initial bioprosthesis should therefore consider the relative safety and efficacy of potential subsequent interventions. The aim of this study was to compare TAVR in failed transcatheter aortic valves (TAVs) versus surgical aortic valves (SAVs). Data were collected on 434 TAV-in-TAV and 624 TAV-in-SAV consecutive procedures performed at centers participating in the Redo-TAVR international registry. Propensity score matching was applied, and 330 matched (165:165) patients were analyzed. Principal endpoints were procedural success, procedural safety, and mortality at 30 days and 1 year. For TAV-in-TAV versus TAV-in-SAV, procedural success was observed in 120 (72.7%) versus 103 (62.4%) patients (p = 0.045), driven by a numerically lower frequency of residual high valve gradient (p = 0.095), ectopic valve deployment (p = 0.081), coronary obstruction (p = 0.091), and conversion to open heart surgery (p = 0.082). Procedural safety was achieved in 116 (70.3%) versus 119 (72.1%) patients (p = 0.715). Mortality at 30 days was 5 (3%) after TAV-in-TAV and 7 (4.4%) after TAV-in-SAV (p = 0.570). At 1 year, mortality was 12 (11.9%) and 10 (10.2%), respectively (p = 0.633). Aortic valve area was larger (1.55 ± 0.5 cm2 vs. 1.37 ± 0.5 cm2; p = 0.040), and the mean residual gradient was lower (12.6 ± 5.2 mm Hg vs. 14.9 ± 5.2 mm Hg; p = 0.011) after TAV-in-TAV. The rate of moderate or greater residual aortic regurgitation was similar, but mild aortic regurgitation was more frequent after TAV-in-TAV (p = 0.003). In propensity score–matched cohorts of TAV-in-TAV versus TAV-in-SAV patients, TAV-in-TAV was associated with higher procedural success and similar procedural safety or mortality.