Meta‐analysis comparing valve‐in‐valve TAVR and redo‐SAVR in patients with degenerated bioprosthetic aortic valve. Issue 5 (10th June 2021)

• Record Type: Journal Article
• Authors: Saleem, Sameer; Ullah, Waqas; Syed, Mubbasher Ameer; Megaly, Michael; Thalambedu, Nishanth; Younas, Sundas; Zahid, Salman; Alam, Mahboob; Virani, Salim S.; Verma, Divya Ratan; Abdul‐Waheed, Mohammad; Fischman, David L.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 98:Issue 5(2021)
• Page Start: 940
• Page End: 947
• Publication Date: 2021-06-10
• Subjects: aortic disease -- aortic valve disease -- surgery -- valvular -- transcatheter valve implantation; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.29789
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Introduction: The comparative efficacy and safety of valve‐in‐valve transcatheter aortic valve replacement (ViV‐TAVR) and redo‐surgical AVR (redo‐SAVR) in patients with degenerated bioprosthetic aortic valves remain unknown. Method: Digital databases were searched to identify relevant articles. Unadjusted odds ratios for dichotomous outcomes were calculated using a random effect model. A total of 11 studies comprising 8326 patients (ViV‐TAVR = 4083 and redo‐SAVR = 4243) were included. Results: The mean age of patients undergoing ViV‐TAVR was older, 76 years compared to 73 years for those undergoing SAVR. The baseline characteristics for patients in ViV‐TAVR vs. redo‐SAVR groups were comparable. At 30‐days, the odds of all‐cause mortality (OR 0.45, 95% CI 0.30–0.68, p = .0002), cardiovascular mortality (OR 0.44, 95% CI 0.26–0.73, p = .001) and major bleeding (OR 0.29, 95% CI 0.15–0.54, p = .0001) were significantly lower in patients undergoing ViV‐TAVR compared to redo‐SAVR. There were no significant differences in the odds of cerebrovascular accidents (OR 0.91, 95% CI 0.52–1.58, p = .74), myocardial infarction (OR 0.92, 95% CI 0.44–1.92, p = .83) and permanent pacemaker implantation (PPM) (OR 0.54, 95% CI 0.27–1.07, p = .08) between the two groups. During mid to long‐term follow up (6‐months to 5‐years), there were no significant differences between ViV‐TAVR and redo‐SAVR for all‐cause mortality, cardiovascular mortality and stroke. ViV‐TAVR was, however, associated with higher risk of prosthesis‐patient mismatch and greater transvalvular pressure gradient post‐implantation. Conclusion: ViV‐TAVR compared to redo‐SAVR appears to be associated with significant improvement in short term mortality and major bleeding. For mid to long‐term follow up, the outcomes were similar for both groups.