TY - JOUR
T1 - Comparison of in-hospital outcomes and readmissions for valve-in-valve transcatheter aortic valve replacement vs. reoperative surgical aortic valve replacement
T2 - A contemporary assessment of real-world outcomes
AU - Hirji, Sameer A.
AU - Percy, Edward D.
AU - Zogg, Cheryl K.
AU - Malarczyk, Alexandra
AU - Harloff, Morgan T.
AU - Yazdchi, Farhang
AU - Kaneko, Tsuyoshi
N1 - Funding Information:
C.Z. is supported by the National Institute of Health Medical Scientist Training Program Training [T32GM007205]. She is the Principal investigator of an F30 award through the National Institute on Aging F30AG066371 entitled 'The ED.TRAUMA Study: Evaluating the Discordance of Trauma Readmission and Unanticipated Mortality in the Assessment of hospital quality'.
Funding Information:
C.Z. is supported by the National Institute of Health Medical Scientist Training Program Training [T32GM007205]. She is the Principal investigator of an F30 award through the National Institute on Aging F30AG066371 entitled ‘The ED.TRAUMA Study: Evaluating the Discordance of Trauma Readmission and Unanticipated Mortality in the Assessment of hospital quality’.
Publisher Copyright:
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Aims We sought to perform a head-to-head comparison of contemporary 30-day outcomes and readmissions between valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) patients and a matched cohort of high-risk reoperative surgical aortic valve replacement (re-SAVR) patients using a large, multicentre, national database. Methods We utilized the nationally weighted 2012-16 National Readmission Database claims to identify all US adult patients and results with degenerated bioprosthetic aortic valves who underwent either VIV-TAVR (n = 3443) or isolated re-SAVR (n = 3372). Thirty-day outcomes were compared using multivariate analysis and propensity score matching (1:1). Unadjusted, VIV-TAVR patients had significantly lower 30-day mortality (2.7% vs. 5.0%), 30-day morbidity (66.4% vs. 79%), and rates of major bleeding (35.8% vs. 50%). On multivariable analysis, re-SAVR was a significant risk factor for both 30-day mortality [adjusted odds ratio (aOR) of VIV-SAVR (vs. re-SAVR) 0.48, 95% confidence interval (CI) 0.28-0.81] and 30-day morbidity [aOR for VIV-TAVR (vs. re-SAVR) 0.54, 95% CI 0.43-0.68]. After matching (n = 2181 matched pairs), VIV-TAVR was associated with lower odds of 30-day mortality (OR 0.41, 95% CI 0.23-0.74), 30-day morbidity (OR 0.53, 95% CI 0.43-0.72), and major bleeding (OR 0.66, 95% CI 0.51-0.85). Valve-in-valve TAVR was also associated with shorter length of stay (median savings of 2 days, 95% CI 1.3-2.7) and higher odds of routine home discharges (OR 2.11, 95% CI 1.61-2.78) compared to re-SAVR. Conclusion In this large, nationwide study of matched high-risk patients with degenerated bioprosthetic aortic valves, VIV-TAVR appears to confer an advantage over re-SAVR in terms of 30-day mortality, morbidity, and bleeding complications. Further studies are warranted to benchmark in low- and intermediate-risk patients and to adequately assess longer-term efficacy.
AB - Aims We sought to perform a head-to-head comparison of contemporary 30-day outcomes and readmissions between valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) patients and a matched cohort of high-risk reoperative surgical aortic valve replacement (re-SAVR) patients using a large, multicentre, national database. Methods We utilized the nationally weighted 2012-16 National Readmission Database claims to identify all US adult patients and results with degenerated bioprosthetic aortic valves who underwent either VIV-TAVR (n = 3443) or isolated re-SAVR (n = 3372). Thirty-day outcomes were compared using multivariate analysis and propensity score matching (1:1). Unadjusted, VIV-TAVR patients had significantly lower 30-day mortality (2.7% vs. 5.0%), 30-day morbidity (66.4% vs. 79%), and rates of major bleeding (35.8% vs. 50%). On multivariable analysis, re-SAVR was a significant risk factor for both 30-day mortality [adjusted odds ratio (aOR) of VIV-SAVR (vs. re-SAVR) 0.48, 95% confidence interval (CI) 0.28-0.81] and 30-day morbidity [aOR for VIV-TAVR (vs. re-SAVR) 0.54, 95% CI 0.43-0.68]. After matching (n = 2181 matched pairs), VIV-TAVR was associated with lower odds of 30-day mortality (OR 0.41, 95% CI 0.23-0.74), 30-day morbidity (OR 0.53, 95% CI 0.43-0.72), and major bleeding (OR 0.66, 95% CI 0.51-0.85). Valve-in-valve TAVR was also associated with shorter length of stay (median savings of 2 days, 95% CI 1.3-2.7) and higher odds of routine home discharges (OR 2.11, 95% CI 1.61-2.78) compared to re-SAVR. Conclusion In this large, nationwide study of matched high-risk patients with degenerated bioprosthetic aortic valves, VIV-TAVR appears to confer an advantage over re-SAVR in terms of 30-day mortality, morbidity, and bleeding complications. Further studies are warranted to benchmark in low- and intermediate-risk patients and to adequately assess longer-term efficacy.
KW - Failed bioprostheses
KW - Reoperative surgical aortic valve replacement
KW - Valve-in-valve TAVR
UR - http://www.scopus.com/inward/record.url?scp=85089129094&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehaa252
DO - 10.1093/eurheartj/ehaa252
M3 - Article
C2 - 32445575
AN - SCOPUS:85089129094
SN - 0195-668X
VL - 41
SP - 2747
EP - 2755
JO - European heart journal
JF - European heart journal
IS - 29
ER -