TY - JOUR
T1 - Valve-in-valve transcatheter aortic valve replacement or re-surgical aortic valve replacement in degenerated bioprostheses
T2 - A systematic review and meta-analysis of short and midterm results
AU - Bruno, Francesco
AU - Elia, Edoardo
AU - D'Ascenzo, Fabrizio
AU - Marengo, Giorgio
AU - Deharo, Pierre
AU - Kaneko, Tsuyoshi
AU - Cuisset, Thomas
AU - Fauchier, Laurent
AU - De Filippo, Ovidio
AU - Gallone, Guglielmo
AU - Andreis, Alessandro
AU - Fortuni, Federico
AU - Salizzoni, Stefano
AU - La Torre, Michele
AU - Rinaldi, Mauro
AU - De Ferrari, Gaetano M.
AU - Conrotto, Federico
N1 - Publisher Copyright:
© 2022 Wiley Periodicals LLC.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - Introduction: Despite limited to short and midterm outcomes, valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as a valid alternative to re-surgical aortic valve replacement (re-SAVR) for high- and intermediate-risk patients with degenerated surgical bioprosthesis. Methods: All studies comparing multivariate adjustment between ViV TAVI and re-SAVR were screened. The primary end-points were all-cause and cardiovascular (CV) mortality at 30 days and at Midterm follow-up. Short-term complications were the secondary endpoints. Results: We obtained data from 11 studies, encompassing 8570 patients, 4224 undergoing ViV TAVI, and 4346 re-SAVR. Four studies included intermediate-risk patients and seven high-risk patients. 30-day all-cause and CV mortality were significantly lower in ViV (odds ratio [OR] 0.43, 95% confidence intervals [CIs] 0.29–0.64 and OR 0.44, 0.26–0.73 respectively), while after a mean follow-up of 717 (180–1825) days, there was no difference between the two groups (OR 1.04, 0.87–1.25 and OR 1.05, 0.78–1.43, respectively). The risk of stroke (OR 1.03, 0.59–1.82), MI (OR 0.70, 0.34–1.44), major vascular complications (OR 0.92, 0.50–1.67), and permanent pacemaker implantation (OR 0.67, 0.36–1.25) at 30 days did not differ, while major bleedings and new-onset atrial fibrillation were significantly lower in ViV patients (OR 0.41, 0.25–0.67 and OR 0.23, 0.12–0.42, respectively, all 95% CIs). Conclusions: In high- and intermediate-risk patients with degenerated surgical bioprostheses, ViV TAVI is associated with reduced short-term mortality, compared with re-SAVR. Nevertheless, no differences were found in all-cause and CV mortality at midterm follow-up. PROSPERO CRD42021226488.
AB - Introduction: Despite limited to short and midterm outcomes, valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as a valid alternative to re-surgical aortic valve replacement (re-SAVR) for high- and intermediate-risk patients with degenerated surgical bioprosthesis. Methods: All studies comparing multivariate adjustment between ViV TAVI and re-SAVR were screened. The primary end-points were all-cause and cardiovascular (CV) mortality at 30 days and at Midterm follow-up. Short-term complications were the secondary endpoints. Results: We obtained data from 11 studies, encompassing 8570 patients, 4224 undergoing ViV TAVI, and 4346 re-SAVR. Four studies included intermediate-risk patients and seven high-risk patients. 30-day all-cause and CV mortality were significantly lower in ViV (odds ratio [OR] 0.43, 95% confidence intervals [CIs] 0.29–0.64 and OR 0.44, 0.26–0.73 respectively), while after a mean follow-up of 717 (180–1825) days, there was no difference between the two groups (OR 1.04, 0.87–1.25 and OR 1.05, 0.78–1.43, respectively). The risk of stroke (OR 1.03, 0.59–1.82), MI (OR 0.70, 0.34–1.44), major vascular complications (OR 0.92, 0.50–1.67), and permanent pacemaker implantation (OR 0.67, 0.36–1.25) at 30 days did not differ, while major bleedings and new-onset atrial fibrillation were significantly lower in ViV patients (OR 0.41, 0.25–0.67 and OR 0.23, 0.12–0.42, respectively, all 95% CIs). Conclusions: In high- and intermediate-risk patients with degenerated surgical bioprostheses, ViV TAVI is associated with reduced short-term mortality, compared with re-SAVR. Nevertheless, no differences were found in all-cause and CV mortality at midterm follow-up. PROSPERO CRD42021226488.
KW - bioprostheses degeneration
KW - re-surgical aortic valve replacement
KW - valve-in-valve TAVI
UR - http://www.scopus.com/inward/record.url?scp=85129426376&partnerID=8YFLogxK
U2 - 10.1002/ccd.30219
DO - 10.1002/ccd.30219
M3 - Article
C2 - 35485723
AN - SCOPUS:85129426376
SN - 1522-1946
VL - 100
SP - 122
EP - 130
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 1
ER -