Transcatheter Valve-in-Valve vs. Redo Surgical Aortic Valve Replacement
- Using a national administrative hospital-discharge database from France, ViV TAVR was associated with a lower rate of a composite endpoint of all-cause mortality, all-cause stroke, MI, or major or life-threatening bleeding.
- Longer-term outcomes (median 516 days) for the combined endpoint of cardiovascular death, all-cause stroke, MI, or rehospitalization for heart failure was not different between ViV TAVR and redo SAVR.
- ViV TAVR was associated with higher rates of pacemaker implantation and rehospitalization for heart failure.
What are the nationwide level outcomes in France for valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) versus redo surgical aortic valve replacement (SAVR) in the setting of bioprosthesis failure?
Using a national administrative hospital-discharge database covering the entire French population, information was extracted for patients treated for aortic bioprosthesis failure with isolated ViV TAVR or redo SAVR between January 2010 and June 2019. Propensity score matching was used for the analysis of outcomes.
A total of 4,327 patients were found in the database. After matching on baseline characteristics, 717 patients were analyzed in each arm. At 30 days, ViV TAVR was associated with lower rates of the composite endpoint of all-cause mortality, all-cause stroke, myocardial infarction (MI), or major or life-threatening bleeding (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.44-0.88; p = 0.03). During follow-up (median 516 days), the combined endpoint of cardiovascular death, all-cause stroke, MI, or rehospitalization for heart failure was not different between the two groups (OR, 1.18; 95% CI, 0.99-1.41; p = 0.26). Individual outcomes of pacemaker implantation and rehospitalization for heart failure were reported more frequently in the ViV TAVR group.
The authors concluded that ViV TAVR was associated with better short-term outcomes compared to redo SAVR. Major cardiovascular outcomes were not different between the two treatments during long-term follow-up.
This retrospective, administrative hospital-discharge database review between 2010 and 2019 in France found that ViV TAVR was associated with better short-term outcomes using a combined endpoint of all-cause mortality, all-cause stroke, MI, and major or life-threatening bleeding compared to redo SAVR for bioprosthetic aortic valve failure; and similar longer-term outcomes using a composite endpoint of cardiovascular death, all-cause stroke, MI, or rehospitalization for heart failure. However, longer-term rates of pacemaker implantation and rehospitalization for heart failure occurred more frequently after ViV TAVR. Aside from the inherent limitations and biases associated with a retrospective review based on an administrative database, additional confounders may exist in terms of two time-dependent phenomena: an increase in experience with TAVR, and a decline in patient risk, as the use of TAVR progressively penetrated moderate- and low-risk populations. Although not without its limitations, this study provides further data to support the use of ViV TAVR among appropriate patients with structural deterioration of an aortic valve bioprosthesis.
Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease
Keywords: Bioprosthesis, Cardiac Surgical Procedures, Heart Failure, Heart Valve Diseases, Heart Valve Prosthesis, Hemorrhage, Myocardial Infarction, Pacemaker, Artificial, Patient Discharge, Stroke, Transcatheter Aortic Valve Replacement, Vascular Diseases
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