Contemporary Outcome Trends in Transcatheter Aortic Valve-in-Valve Implantation Versus Redo Aortic Valve Replacement
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Contemporary Outcome Trends in Transcatheter Aortic Valve-in-Valve Implantation Versus Redo Aortic Valve Replacement. / Demal, Till J; Gordon, Christopher; Bhadra, Oliver D; Linder, Matthias; Ludwig, Sebastian; Grundmann, David; Voigtländer, Lisa; Waldschmidt, Lara; Schirmer, Johannes; Schofer, Niklas; Seiffert, Moritz; Blankenberg, Stefan; Reichenspurner, Hermann; Westermann, Dirk; Conradi, Lenard.
in: AM J CARDIOL, Jahrgang 171, 15.05.2022, S. 115-121.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Contemporary Outcome Trends in Transcatheter Aortic Valve-in-Valve Implantation Versus Redo Aortic Valve Replacement
AU - Demal, Till J
AU - Gordon, Christopher
AU - Bhadra, Oliver D
AU - Linder, Matthias
AU - Ludwig, Sebastian
AU - Grundmann, David
AU - Voigtländer, Lisa
AU - Waldschmidt, Lara
AU - Schirmer, Johannes
AU - Schofer, Niklas
AU - Seiffert, Moritz
AU - Blankenberg, Stefan
AU - Reichenspurner, Hermann
AU - Westermann, Dirk
AU - Conradi, Lenard
N1 - Copyright © 2022 Elsevier Inc. All rights reserved.
PY - 2022/5/15
Y1 - 2022/5/15
N2 - As valve-in-valve (ViV) transcatheter aortic valve implantation is still an evolving method, we evaluated the development of early and midterm outcomes after ViV and conventional redo-surgical aortic valve replacement (SAVR) over the past 2 decades. In-hospital databases were retrospectively screened for patients ≥60 years treated for failing bioprosthetic aortic valves at our center. Clinical and follow-up characteristics were compared between patients who underwent ViV or redo-SAVR according to valve academic research consortium-2 (VARC-2) definitions. The comparison of outcome parameters was adjusted for baseline differences between groups. Between June 2002 and April 2020, 209 patients with ViV and 65 redo-SAVR patients met inclusion criteria. No significant differences were found in 30 days (ViV 3.8%, SAVR 3.1%, p = 0.778) or 6-month mortality (ViV 14.0%, SAVR 7.5%, p = 0.283). As patients with ViV less frequently experienced acute kidney injury (stage II or III) and life-threatening bleeding, they more frequently reached the 30-day VARC-2 combined safety end point (79.2% vs 61.5%, odds ratio [OR] 2.540, p = 0.023). Patients with ViV less frequently reached clinical efficacy (68.3% vs 84.6%, OR 0.408, p = 0.041) and device success (79.9% vs 92.3%, OR 0.311, p = 0.040) end points, because of higher frequency of postprocedural transvalvular gradients >20 mm Hg. However, over the past decade, VARC-2 clinical efficacy and device success rates continuously increased in ViV cases. In conclusion, ViV and SAVR were associated with similar acute mortality and different beneficial and adverse outcome profiles in this single-center cohort. Results after ViV procedures have continuously improved over the past years.
AB - As valve-in-valve (ViV) transcatheter aortic valve implantation is still an evolving method, we evaluated the development of early and midterm outcomes after ViV and conventional redo-surgical aortic valve replacement (SAVR) over the past 2 decades. In-hospital databases were retrospectively screened for patients ≥60 years treated for failing bioprosthetic aortic valves at our center. Clinical and follow-up characteristics were compared between patients who underwent ViV or redo-SAVR according to valve academic research consortium-2 (VARC-2) definitions. The comparison of outcome parameters was adjusted for baseline differences between groups. Between June 2002 and April 2020, 209 patients with ViV and 65 redo-SAVR patients met inclusion criteria. No significant differences were found in 30 days (ViV 3.8%, SAVR 3.1%, p = 0.778) or 6-month mortality (ViV 14.0%, SAVR 7.5%, p = 0.283). As patients with ViV less frequently experienced acute kidney injury (stage II or III) and life-threatening bleeding, they more frequently reached the 30-day VARC-2 combined safety end point (79.2% vs 61.5%, odds ratio [OR] 2.540, p = 0.023). Patients with ViV less frequently reached clinical efficacy (68.3% vs 84.6%, OR 0.408, p = 0.041) and device success (79.9% vs 92.3%, OR 0.311, p = 0.040) end points, because of higher frequency of postprocedural transvalvular gradients >20 mm Hg. However, over the past decade, VARC-2 clinical efficacy and device success rates continuously increased in ViV cases. In conclusion, ViV and SAVR were associated with similar acute mortality and different beneficial and adverse outcome profiles in this single-center cohort. Results after ViV procedures have continuously improved over the past years.
KW - Aortic Valve/surgery
KW - Aortic Valve Stenosis/etiology
KW - Bioprosthesis
KW - Heart Valve Prosthesis
KW - Heart Valve Prosthesis Implantation/methods
KW - Humans
KW - Reoperation
KW - Retrospective Studies
KW - Risk Factors
KW - Transcatheter Aortic Valve Replacement/methods
KW - Treatment Outcome
U2 - 10.1016/j.amjcard.2022.01.049
DO - 10.1016/j.amjcard.2022.01.049
M3 - SCORING: Journal article
C2 - 35307189
VL - 171
SP - 115
EP - 121
JO - AM J CARDIOL
JF - AM J CARDIOL
SN - 0002-9149
ER -