Transcatheter valve-in-valve implantation versus redo surgical aortic valve replacement in patients with failed aortic bioprostheses

Miriam Silaschi; Olaf Wendler; Moritz Seiffert; Liesa Castro; Edith Lubos; Johannes Schirmer; Stefan Blankenberg; Hermann Reichenspurner; Ulrich Schäfer; Hendrik Treede; Philip MacCarthy; Lenard Conradi

doi:10.1093/ICVTS/IVW302

Transcatheter valve-in-valve implantation versus redo surgical aortic valve replacement in patients with failed aortic bioprostheses

Miriam Silaschi, Olaf Wendler^*, Moritz Seiffert, Liesa Castro, Edith Lubos, Johannes Schirmer, Stefan Blankenberg, Hermann Reichenspurner, Ulrich Schäfer, Hendrik Treede, Philip MacCarthy, Lenard Conradi

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

59 Citations (Scopus)

Abstract

OBJECTIVES: Transcatheter aortic valve-in-valve implantation (ViV) is a new treatment for failing bioprostheses (BP) in patients with high surgical risk. However, comparative data, using standard repeat surgical aortic valve replacement (redo-SAVR), are scarce. We compared outcomes after ViV with those after conventional redo-SAVR in two European centres with established interventional programmes. METHODS: In-hospital databases were retrospectively screened for patients ?60 years, treated for failing aortic BP. Cases of infective endocarditis or combined procedures were excluded. End-points were adjudicated according to the Valve Academic Research Consortium (VARC-2) criteria. RESULTS: From 2002 to 2015, 130 patients were treated (ViV: n = 71, redo-SAVR: n = 59). Age and logistic EuroSCORE I scores were higher with ViV (78.6 7.5 vs 72.9 6.6 years, P 0.01; 25.1 18.9 vs 16.8 9.3%, P 0.01). The 30-day mortality rate was not significantly different (4.2 and 5.1%, respectively) (P = 1.0). Device success was achieved in 52.1% (ViV) and 91.5% (P 0.01). No stroke was observed after ViV but in 3.4% after redo-SAVR (P = 0.2). Intensive care stay was longer after redo-SAVR (3.4 2.9 vs 2.0 1.8 days, P 0.01). Mean transvalvular gradients were higher post-ViV (19.7 7.7 vs12.2 5.7 mmHg, P 0.01), whereas the rate of permanent pacemaker implantation was lower (9.9 vs 25.4%, P 0.01). Survival rates at 90 and180 days were 94.2 and 92.3% vs 92.8 and 92.8% (P = 0.87), respectively. CONCLUSIONS: Despite a higher risk profile in the ViV group, early mortality rates were not different compared with those of surgery. Although ViV resulted in elevated transvalvular gradients and therefore a lower rate of device success, mortality rates were similar to those with redo-SAVR. At present, both techniques serve as complementary approaches, and allow individualized patient care with excellent outcomes.

Original language	English
Pages (from-to)	63-70
Number of pages	8
Journal	Interactive cardiovascular and thoracic surgery
Volume	24
Issue number	1
DOIs	https://doi.org/10.1093/ICVTS/IVW302
Publication status	Published - 1 Jan 2017

Keywords

Prosthesis
Surgery
Transcatheter valve therapy
Valve disease

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/ICVTS/IVW302

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Silaschi, M., Wendler, O., Seiffert, M., Castro, L., Lubos, E., Schirmer, J., Blankenberg, S., Reichenspurner, H., Schäfer, U., Treede, H., MacCarthy, P., & Conradi, L. (2017). Transcatheter valve-in-valve implantation versus redo surgical aortic valve replacement in patients with failed aortic bioprostheses. Interactive cardiovascular and thoracic surgery, 24(1), 63-70. https://doi.org/10.1093/ICVTS/IVW302

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title = "Transcatheter valve-in-valve implantation versus redo surgical aortic valve replacement in patients with failed aortic bioprostheses",

abstract = "OBJECTIVES: Transcatheter aortic valve-in-valve implantation (ViV) is a new treatment for failing bioprostheses (BP) in patients with high surgical risk. However, comparative data, using standard repeat surgical aortic valve replacement (redo-SAVR), are scarce. We compared outcomes after ViV with those after conventional redo-SAVR in two European centres with established interventional programmes. METHODS: In-hospital databases were retrospectively screened for patients ?60 years, treated for failing aortic BP. Cases of infective endocarditis or combined procedures were excluded. End-points were adjudicated according to the Valve Academic Research Consortium (VARC-2) criteria. RESULTS: From 2002 to 2015, 130 patients were treated (ViV: n = 71, redo-SAVR: n = 59). Age and logistic EuroSCORE I scores were higher with ViV (78.6 7.5 vs 72.9 6.6 years, P 0.01; 25.1 18.9 vs 16.8 9.3%, P 0.01). The 30-day mortality rate was not significantly different (4.2 and 5.1%, respectively) (P = 1.0). Device success was achieved in 52.1% (ViV) and 91.5% (P 0.01). No stroke was observed after ViV but in 3.4% after redo-SAVR (P = 0.2). Intensive care stay was longer after redo-SAVR (3.4 2.9 vs 2.0 1.8 days, P 0.01). Mean transvalvular gradients were higher post-ViV (19.7 7.7 vs12.2 5.7 mmHg, P 0.01), whereas the rate of permanent pacemaker implantation was lower (9.9 vs 25.4%, P 0.01). Survival rates at 90 and180 days were 94.2 and 92.3% vs 92.8 and 92.8% (P = 0.87), respectively. CONCLUSIONS: Despite a higher risk profile in the ViV group, early mortality rates were not different compared with those of surgery. Although ViV resulted in elevated transvalvular gradients and therefore a lower rate of device success, mortality rates were similar to those with redo-SAVR. At present, both techniques serve as complementary approaches, and allow individualized patient care with excellent outcomes.",

keywords = "Prosthesis, Surgery, Transcatheter valve therapy, Valve disease",

author = "Miriam Silaschi and Olaf Wendler and Moritz Seiffert and Liesa Castro and Edith Lubos and Johannes Schirmer and Stefan Blankenberg and Hermann Reichenspurner and Ulrich Sch{\"a}fer and Hendrik Treede and Philip MacCarthy and Lenard Conradi",

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doi = "10.1093/ICVTS/IVW302",

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volume = "24",

pages = "63--70",

journal = "Interactive cardiovascular and thoracic surgery",

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Silaschi, M, Wendler, O, Seiffert, M, Castro, L, Lubos, E, Schirmer, J, Blankenberg, S, Reichenspurner, H, Schäfer, U, Treede, H, MacCarthy, P & Conradi, L 2017, 'Transcatheter valve-in-valve implantation versus redo surgical aortic valve replacement in patients with failed aortic bioprostheses', Interactive cardiovascular and thoracic surgery, vol. 24, no. 1, pp. 63-70. https://doi.org/10.1093/ICVTS/IVW302

TY - JOUR

T1 - Transcatheter valve-in-valve implantation versus redo surgical aortic valve replacement in patients with failed aortic bioprostheses

AU - Silaschi, Miriam

AU - Wendler, Olaf

AU - Seiffert, Moritz

AU - Castro, Liesa

AU - Lubos, Edith

AU - Schirmer, Johannes

AU - Blankenberg, Stefan

AU - Reichenspurner, Hermann

AU - Schäfer, Ulrich

AU - Treede, Hendrik

AU - MacCarthy, Philip

AU - Conradi, Lenard

PY - 2017/1/1

Y1 - 2017/1/1

N2 - OBJECTIVES: Transcatheter aortic valve-in-valve implantation (ViV) is a new treatment for failing bioprostheses (BP) in patients with high surgical risk. However, comparative data, using standard repeat surgical aortic valve replacement (redo-SAVR), are scarce. We compared outcomes after ViV with those after conventional redo-SAVR in two European centres with established interventional programmes. METHODS: In-hospital databases were retrospectively screened for patients ?60 years, treated for failing aortic BP. Cases of infective endocarditis or combined procedures were excluded. End-points were adjudicated according to the Valve Academic Research Consortium (VARC-2) criteria. RESULTS: From 2002 to 2015, 130 patients were treated (ViV: n = 71, redo-SAVR: n = 59). Age and logistic EuroSCORE I scores were higher with ViV (78.6 7.5 vs 72.9 6.6 years, P 0.01; 25.1 18.9 vs 16.8 9.3%, P 0.01). The 30-day mortality rate was not significantly different (4.2 and 5.1%, respectively) (P = 1.0). Device success was achieved in 52.1% (ViV) and 91.5% (P 0.01). No stroke was observed after ViV but in 3.4% after redo-SAVR (P = 0.2). Intensive care stay was longer after redo-SAVR (3.4 2.9 vs 2.0 1.8 days, P 0.01). Mean transvalvular gradients were higher post-ViV (19.7 7.7 vs12.2 5.7 mmHg, P 0.01), whereas the rate of permanent pacemaker implantation was lower (9.9 vs 25.4%, P 0.01). Survival rates at 90 and180 days were 94.2 and 92.3% vs 92.8 and 92.8% (P = 0.87), respectively. CONCLUSIONS: Despite a higher risk profile in the ViV group, early mortality rates were not different compared with those of surgery. Although ViV resulted in elevated transvalvular gradients and therefore a lower rate of device success, mortality rates were similar to those with redo-SAVR. At present, both techniques serve as complementary approaches, and allow individualized patient care with excellent outcomes.

AB - OBJECTIVES: Transcatheter aortic valve-in-valve implantation (ViV) is a new treatment for failing bioprostheses (BP) in patients with high surgical risk. However, comparative data, using standard repeat surgical aortic valve replacement (redo-SAVR), are scarce. We compared outcomes after ViV with those after conventional redo-SAVR in two European centres with established interventional programmes. METHODS: In-hospital databases were retrospectively screened for patients ?60 years, treated for failing aortic BP. Cases of infective endocarditis or combined procedures were excluded. End-points were adjudicated according to the Valve Academic Research Consortium (VARC-2) criteria. RESULTS: From 2002 to 2015, 130 patients were treated (ViV: n = 71, redo-SAVR: n = 59). Age and logistic EuroSCORE I scores were higher with ViV (78.6 7.5 vs 72.9 6.6 years, P 0.01; 25.1 18.9 vs 16.8 9.3%, P 0.01). The 30-day mortality rate was not significantly different (4.2 and 5.1%, respectively) (P = 1.0). Device success was achieved in 52.1% (ViV) and 91.5% (P 0.01). No stroke was observed after ViV but in 3.4% after redo-SAVR (P = 0.2). Intensive care stay was longer after redo-SAVR (3.4 2.9 vs 2.0 1.8 days, P 0.01). Mean transvalvular gradients were higher post-ViV (19.7 7.7 vs12.2 5.7 mmHg, P 0.01), whereas the rate of permanent pacemaker implantation was lower (9.9 vs 25.4%, P 0.01). Survival rates at 90 and180 days were 94.2 and 92.3% vs 92.8 and 92.8% (P = 0.87), respectively. CONCLUSIONS: Despite a higher risk profile in the ViV group, early mortality rates were not different compared with those of surgery. Although ViV resulted in elevated transvalvular gradients and therefore a lower rate of device success, mortality rates were similar to those with redo-SAVR. At present, both techniques serve as complementary approaches, and allow individualized patient care with excellent outcomes.

KW - Prosthesis

KW - Surgery

KW - Transcatheter valve therapy

KW - Valve disease

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U2 - 10.1093/ICVTS/IVW302

DO - 10.1093/ICVTS/IVW302

M3 - Article

C2 - 27624352

AN - SCOPUS:85028667163

SN - 1569-9293

VL - 24

SP - 63

EP - 70

JO - Interactive cardiovascular and thoracic surgery

JF - Interactive cardiovascular and thoracic surgery

IS - 1

ER -

Transcatheter valve-in-valve implantation versus redo surgical aortic valve replacement in patients with failed aortic bioprostheses

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UN SDGs

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