Early and Midterm Clinical Outcomes of Transcatheter Valve-in-Valve Implantation Versus Redo Surgical Aortic Valve Replacement for Aortic Bioprosthetic Valve Degeneration: Two Faces of the Same Medal.

Autor: Dokollari A; Cardiac Surgery Department, Saint Michael's Hospital, Toronto, Canada; Cardiac Surgery, CARIM, Maastricht University Medical Center, Maastricht, Netherlands. Electronic address: aleksanderdokollari2@gmail.com., Cameli M; Le Scotte Hospital, University of Siena, Siena, Italy., Mandoli GE; Le Scotte Hospital, University of Siena, Siena, Italy., Kalra DS; North York, Canada., Poston R; SUNY Downstate Hospital, Brooklyn, NY., Coku L; University of New Mexico School of Medicine, Albuquerque, NM., Pernoci M; Toronto, Canada., Miri M; Toronto, Canada., Bonacchi M; Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy., Gelsomino S; Cardiac Surgery, CARIM, Maastricht University Medical Center, Maastricht, Netherlands.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2021 Nov; Vol. 35 (11), pp. 3223-3231. Date of Electronic Publication: 2021 May 24.
DOI: 10.1053/j.jvca.2021.05.029
Abstrakt: Objective: To compare early and midterm outcomes of transcatheter valve-in-valve implantation (ViV-TAVI) and redo surgical aortic valve replacement (re-SAVR) for aortic bioprosthetic valve degeneration.
Design: Patients who underwent ViV-TAVI and re-SAVR for aortic bioprosthetic valve degeneration between January 2010 and October 2018 were retrospectively analyzed. Mean follow-up was 3.0 years.
Setting: In-hospital, early, and mid-term outcomes.
Participants: Eighty-eight patients were included in the analysis.
Interventions: Thirty-one patients (37.3%) had ViV-TAVI, and 57 patients (62.7%) had re-SAVR.
Measurements and Main Results: In the ViV-TAVI group, patients were older (79.1 ± 7.4 v 67.2 ± 14.1, p < 0.01). The total operative time, intubation time, intensive care unit length of stay, total hospital length of stay, inotropes infusion, intubation >24 hours, total amount of chest tube losses, red blood cell transfusions, plasma transfusions, and reoperation for bleeding were significantly higher in the re-SAVR cohort (p < 0.01). There was no difference regarding in-hospital permanent pacemaker implantation (ViV-TAVI = 3.2% v re-SAVR = 8.8%, p = 0.27), patient-prosthesis mismatch (ViV-TAVI = 12 patients [mean 0.53 ± 0.07] and re-SAVR = ten patients [mean 0.56 ± 0.08], p = 0.4), stroke (ViV-TAVI = 3.2% v re-SAVR = 7%, p = 0.43), acute kidney injury (ViV-TAVI = 9.7% v re-SAVR = 15.8%, p = 0.1), and all-cause infections (ViV-TAVI = 0% v re-SAVR = 8.8%, p = 0.02), between the two groups. In-hospital mortality was 0% and 7% for ViV-TAVI and re-SAVR, respectively (p = 0.08). At three-years' follow-up, the incidence of pacemaker implantation was higher in the re-SAVR group (ViV-TAVI = 0 v re-SAVR = 13.4%, p < 0.01). There were no differences in reintervention (ViV-TAVI = 3.8% v re-SAVR = 0%, p = 0.32) and survival (ViV-TAVI = 83.9% v re-SAVR = 93%, p = 0.10) between the two cohorts.
Conclusions: ViV-TAVI is a safe, feasible, and reliable procedure.
(Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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