TY - JOUR
T1 - Incidence, predictors and outcomes of valve-in-valve TAVI
T2 - A systematic review and meta-analysis
AU - Giordana, Francesca
AU - Bruno, Francesco
AU - Conrotto, Federico
AU - Saglietto, Andrea
AU - D'Ascenzo, Fabrizio
AU - Grosso Marra, Walter
AU - Dvir, Danny
AU - Webb, John
AU - D'Onofrio, Augusto
AU - Camboni, Daniele
AU - Grubitzsch, Herko
AU - Duncan, Alison
AU - Kaneko, Tsuyoshi
AU - Toggweiler, Stefan
AU - Latib, Azeem
AU - Nerla, Roberto
AU - Salizzoni, Stefano
AU - La Torre, Michele
AU - Trompeo, Anna
AU - D'Amico, Maurizio
AU - Rinaldi, Mauro
AU - De Ferrari, Gaetano
N1 - Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Aims: Surgical aortic valve replacement has been the treatment of choice for patients with aortic valve disease before the arrival of transcatheter aortic valve replacement (TAVI), although limited by degeneration of the bioprosthesis. “Redo” intervention itself is burdened by high risk of complications and valve-in-valve (ViV) TAVI could be a valid strategy of redo for patients with comorbidities. Methods and results: Two independent reviewers screened all studies investigating patients undergoing ViV TAVI. Mortality at 30 days and at 1 year was the primary end point. Of 286 studies identified, 26 articles were included in this review with a total of 1448 patients. Median age was 78.8 years, 57.7% male. Median STS score and Logistic EuroSCORE were 9.4% and 31.3% respectively. Stenosis (45%) was the leading cause of prosthesis failure. Transfemoral approach was preferred (76%), with a prevalence of balloon expandable valves (73.3%). Mean follow up was 376 days. Overall and cardiovascular mortality at 30 days was 6.5% and 5.5% respectively, while at 1 year it was 14.5% and 8.9% respectively. At meta-regression analysis study year (p <.001), Logistic EuroSCORE (p <.01) and valve diameter ≤ 21 mm (p <.05) at 30 days, and stenosis as reason for failure (p =.05) at 1 year were identified as possible predictors of survival. Conclusions: ViV TAVI offers a valid strategy to treat high risk patients with a failure of bioprosthesis with satisfying results in terms of short and mid-term mortality. Future studies are needed to find predictors of long term survival and outcomes in lower risk patients.
AB - Aims: Surgical aortic valve replacement has been the treatment of choice for patients with aortic valve disease before the arrival of transcatheter aortic valve replacement (TAVI), although limited by degeneration of the bioprosthesis. “Redo” intervention itself is burdened by high risk of complications and valve-in-valve (ViV) TAVI could be a valid strategy of redo for patients with comorbidities. Methods and results: Two independent reviewers screened all studies investigating patients undergoing ViV TAVI. Mortality at 30 days and at 1 year was the primary end point. Of 286 studies identified, 26 articles were included in this review with a total of 1448 patients. Median age was 78.8 years, 57.7% male. Median STS score and Logistic EuroSCORE were 9.4% and 31.3% respectively. Stenosis (45%) was the leading cause of prosthesis failure. Transfemoral approach was preferred (76%), with a prevalence of balloon expandable valves (73.3%). Mean follow up was 376 days. Overall and cardiovascular mortality at 30 days was 6.5% and 5.5% respectively, while at 1 year it was 14.5% and 8.9% respectively. At meta-regression analysis study year (p <.001), Logistic EuroSCORE (p <.01) and valve diameter ≤ 21 mm (p <.05) at 30 days, and stenosis as reason for failure (p =.05) at 1 year were identified as possible predictors of survival. Conclusions: ViV TAVI offers a valid strategy to treat high risk patients with a failure of bioprosthesis with satisfying results in terms of short and mid-term mortality. Future studies are needed to find predictors of long term survival and outcomes in lower risk patients.
KW - Aortic stenosis
KW - Heart team
KW - Transcatheter aortic valve implantation
KW - Valve-in-valve
UR - http://www.scopus.com/inward/record.url?scp=85086511472&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2020.05.058
DO - 10.1016/j.ijcard.2020.05.058
M3 - Article
C2 - 32470529
AN - SCOPUS:85086511472
SN - 0167-5273
VL - 316
SP - 64
EP - 69
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -