Redo aortic valve replacement versus valve-in-valve trans-catheter aortic valve implantation: a UK propensity-matched analysis

Submitted: February 8, 2023
Accepted: March 21, 2023
Published: April 19, 2023
Abstract Views: 1451
PDF: 319
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Authors

This study sought to compare the morbidity and mortality of redo aortic valve replacement (redo-AVR) versus valve-in-valve trans-catheter aortic valve implantation (valve-in-valve TAVI) for patients with a failing bioprosthetic valve. A multicenter UK retrospective study of redo-AVR or valve-in-valve TAVI for patients referred for redo aortic valve intervention due to a degenerated aortic bioprosthesis. Propensity score matching was performed for confounding factors. From July 2005 to April 2021, 911 patients underwent redo-AVR and 411 patients underwent valve-in-valve TAVI. There were 125 pairs for analysis after propensity score matching. The mean age was 75.2±8.5 years. In-hospital mortality was 7.2% (n=9) for redo-AVR versus 0 for valve-in-valve TAVI, p=0.002. Surgical patients suffered more post-operative complications, including intra-aortic balloon pump support (p=0.02), early re-operation (p<0.001), arrhythmias (p<0.001), respiratory and neurological complications (p=0.02 and p=0.03) and multi-organ failure (p=0.01). The valve-in-valve TAVI group had a shorter intensive care unit and hospital stay (p<0.001 for both). However, moderate aortic regurgitation at discharge and higher post-procedural gradients were more common after valve-in-valve TAVI (p<0.001 for both). Survival probabilities in patients who were successfully discharged from the hospital were similar after valve-in-valve TAVI and redo-AVR over the 6-year follow-up (log-rank p=0.26). In elderly patients with a degenerated aortic bioprosthesis, valve-in-valve TAVI provides better early outcomes as opposed to redo-AVR, although there was no difference in mid-term survival in patients successfully discharged from the hospital.

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Ethics Approval

Institutional review board approval was granted in all participating centers (ethics approval number 1845).

How to Cite

Gatta, Francesca, Yama Haqzad, George Gradinariu, Pietro Giorgio Malvindi, Zubair Khalid, Rona L. Suelo-Calanao, Nader Moawad, Aladdin Bashir, Luke J. Rogers, Clinton Lloyd, Bao Nguyen, Karen Booth, Lu Wang, Nawwar Al-Attar, Neil McDowall, Stuart Watkins, Rana Sayeed, Saleh Baghdadi, Andrea D’Alessio, Maria Monteagudo-vela, Jasmina Djordjevic, Matej Goricar, Solveig Hoppe, Charlotte Bocking, Azar Hussain, Betsy Evans, Salman Arif, Christopher Malkin, Mark Field, Kully Sandhu, Amer Harky, Ahmed Torky, Mauin Uddin, Muhammad Abdulhakeem, Ayman Kenawy, John Massey, Neil Cartwright, Nathan Tyson, Niki Nicou, Kamran Baig, Mark Jones, Firas Aljanadi, Colum G. Owens, Tunde Oyebanji, Joseph Doyle, Mark S. Spence, Paul F. Brennan, Ganesh Manoharan, Taha Ramadan, Sunil Ohri, and Mahmoud Loubani. 2023. “Redo Aortic Valve Replacement <i>versus</i> Valve-in-Valve Trans-Catheter Aortic Valve Implantation: A UK Propensity-Matched Analysis”. Monaldi Archives for Chest Disease 94 (1). https://doi.org/10.4081/monaldi.2023.2546.