Isolated Redo Aortic Valve Replacement Versus Valve-in-Valve Transcatheter Valve Replacement
| Autor: | Bradley G. Leshnower, Kendra J. Grubb, Parth M. Patel, Edward Chiou, Robert A. Guyton, Yichun Cao, Edward P. Chen, Jose N. Binongo |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
Reoperation Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors medicine.medical_treatment Hemodynamics 030204 cardiovascular system & hematology Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Aortic valve replacement Valve replacement Risk Factors Interquartile range Risk of mortality Humans Medicine Survival analysis Aged Retrospective Studies Bioprosthesis Heart Valve Prosthesis Implantation Univariate analysis business.industry Aortic Valve Stenosis Middle Aged medicine.disease Valve in valve Surgery Treatment Outcome 030228 respiratory system Aortic Valve Heart Valve Prosthesis Female Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 112:539-545 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2020.08.048 |
| Popis: | Clinical outcomes of redo surgical aortic valve replacement (redo-SAVR) compared with valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) are poorly understood. This study compared short- and midterm outcomes of patients undergoing isolated redo-SAVR vs VIV-TAVR after previous SAVR.A single-institutional review of the initial use of VIV-TAVR from 2012 to 2019 identified 273 patients undergoing VIV-TAVR (n = 187) or redo-SAVR (n = 86) after prior SAVR. Outcomes analysis included a univariate analysis and Kaplan-Meier survival analysis.The Society of Thoracic Surgeons predicted risk of mortality was higher for VIV-TAVR (6.3%; interquartile range [IQR], 3.6%-10.5%) vs redo-SAVR (4.2%; IQR, 2.4%-6.9%; P.01). VIV-TAVR patients (76 years; IQR, 67.5-82.5 years) were older than redo-SAVR patients (64 years; IQR, 54-72; P.01). Redo-SAVR and VIV-TAVR had similar early mortality (1.2% vs 1.6%, P = .92). Two redo-SAVR (2.3%) and 3 VIV-TAVR patients (1.6%) died 4.8 ± 0.5 years and 4.8 ± 1.5 months after discharge, respectively. Redo-SAVR had an increased stroke rate (7.0% vs 1.1%, P = .02). Postoperative mean valve gradients were similar between VIV-TAVR (14 mm Hg; IQR, 9-21 mm Hg) and redo-SAVR patients (12 mm Hg; IQR, 8-20 mm Hg; P = .08). Postprocedure transesophageal echocardiography showed at least mild aortic insufficiency for 24 VIV-TAVR patients (16%) and 2 redo-SAVR patients (2.9%) (P = .01). The cumulative incidence of aortic valve reintervention was 5.2% for the redo-SAVR patients and 28.5% for the VIV-TAVR patients (P = .07).After previous SAVR, redo-SAVR and VIV-TAVR can both be performed with acceptable operative results. Despite treating a high-risk patient population, we found redo-SAVR and VIV-TAVR both carry similar operative outcomes. Improved valve hemodynamics were observed in redo-SAVR patients compared with VIV-TAVR patients. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|