Article: Redo aortic valve replacement
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace
2023 Volume 94, Issue 1
Abstract: This study sought to compare the morbidity and mortality of redo aortic valve replacement (redo-AVR) versus valve-in-valve trans-catheter aortic valve implantation (valve-in-valve TAVI) for patients with a failing bioprosthetic valve. A multicenter UK ... ...
Abstract | This study sought to compare the morbidity and mortality of redo aortic valve replacement (redo-AVR) versus valve-in-valve trans-catheter aortic valve implantation (valve-in-valve TAVI) for patients with a failing bioprosthetic valve. A multicenter UK retrospective study of redo-AVR or valve-in-valve TAVI for patients referred for redo aortic valve intervention due to a degenerated aortic bioprosthesis. Propensity score matching was performed for confounding factors. From July 2005 to April 2021, 911 patients underwent redo-AVR and 411 patients underwent valve-in-valve TAVI. There were 125 pairs for analysis after propensity score matching. The mean age was 75.2±8.5 years. In-hospital mortality was 7.2% (n=9) for redo-AVR versus 0 for valve-in-valve TAVI, p=0.002. Surgical patients suffered more post-operative complications, including intra-aortic balloon pump support (p=0.02), early re-operation (p<0.001), arrhythmias (p<0.001), respiratory and neurological complications (p=0.02 and p=0.03) and multi-organ failure (p=0.01). The valve-in-valve TAVI group had a shorter intensive care unit and hospital stay (p<0.001 for both). However, moderate aortic regurgitation at discharge and higher post-procedural gradients were more common after valve-in-valve TAVI (p<0.001 for both). Survival probabilities in patients who were successfully discharged from the hospital were similar after valve-in-valve TAVI and redo-AVR over the 6-year follow-up (log-rank p=0.26). In elderly patients with a degenerated aortic bioprosthesis, valve-in-valve TAVI provides better early outcomes as opposed to redo-AVR, although there was no difference in mid-term survival in patients successfully discharged from the hospital. |
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MeSH term(s) | Humans ; Aged ; Aged, 80 and over ; Aortic Valve/surgery ; Heart Valve Prosthesis Implantation/adverse effects ; Retrospective Studies ; Heart Valve Prosthesis ; Aortic Valve Stenosis/surgery ; Catheters ; United Kingdom/epidemiology ; Treatment Outcome ; Risk Factors ; Bioprosthesis/adverse effects | |||||
Language | English | |||||
Publishing date | 2023-04-19 | |||||
Publishing country | Italy | |||||
Document type | Multicenter Study ; Journal Article | |||||
ZDB-ID | 1160940-0 | |||||
ISSN | 1122-0643 ; 1120-0391 | |||||
ISSN | 1122-0643 ; 1120-0391 | |||||
DOI | 10.4081/monaldi.2023.2546 | |||||
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Database | MEDical Literature Analysis and Retrieval System OnLINE |
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