Transcatheter Replacement of Transcatheter Versus Surgically Implanted Aortic Valve Bioprostheses.
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Landes Uri, Sathananthan Janarthanan, Witberg Guy, De Backer Ole, Sondergaard Lars, Abdel-Wahab Mohamed, Holzhey David, Kim Won-Keun, Hamm Christian, Buzzatti Nicola, Montorfano Matteo, Ludwig Sebastian, Conradi Lenard, Seiffert Moritz, Guerrero Mayra, El Sabbagh Abdallah, Rodés-Cabau Josep, Guimaraes Leonardo, Codner Pablo, Okuno Taishi, Pilgrim Thomas, Fiorina Claudia, Colombo Antonio, Mangieri Antonio, Eltchaninoff Helene, Nombela-Franco Luis, Van Wiechen Maarten P H, Van Mieghem Nicolas M, Tchétché Didier, Schoels Wolfgang H, Kullmer Matthias, Tamburino Corrado, Sinning Jan-Malte, Al-Kassou Baravan, Perlman Gidon Y, Danenberg Haim, Ielasi Alfonso, Fraccaro Chiara, Tarantini Giuseppe, De Marco Federico, Redwood Simon R, Lisko John C, Babaliaros Vasilis C, Laine Mika, Nerla Roberto, Castriota Fausto, Finkelstein Ariel, Loewenstein Itamar, Eitan Amnon, Jaffe Ronen, Ruile Philipp, Neumann Franz J, Piazza Nicolo, Alosaimi Hind, Sievert Horst, Sievert Kolja, Russo Marco, Andreas Martin, Bunc Matjaz, Latib Azeem, Godfrey Rebecca, Hildick-Smith David, Chuang Ming-Yu A, Blanke Philipp, Leipsic Jonathon, Wood David A, Nazif Tamim M, Kodali Susheel, Barbanti Marco, Kornowski Ran, Leon Martin B, Webb John G
Аннотация
OBJECTIVES: The aim of this study was to compare TAVR in failed transcatheter aortic valves (TAVs) versus surgical aortic valves (SAVs).
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.