Meta-analysis comparing valve-in-valve TAVR and redo-SAVR in patients with degenerated bioprosthetic aortic valve

Sameer Saleem, Waqas Ullah, Mubbasher Ameer Syed, Michael Megaly, Nishanth Thalambedu, Sundas Younas, Salman Zahid, Mahboob Alam, Salim S. Virani, Divya Ratan Verma, Mohammad Abdul-Waheed, David L. Fischman

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)

Abstract

Introduction: The comparative efficacy and safety of valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) and redo-surgical AVR (redo-SAVR) in patients with degenerated bioprosthetic aortic valves remain unknown. Method: Digital databases were searched to identify relevant articles. Unadjusted odds ratios for dichotomous outcomes were calculated using a random effect model. A total of 11 studies comprising 8326 patients (ViV-TAVR = 4083 and redo-SAVR = 4243) were included. Results: The mean age of patients undergoing ViV-TAVR was older, 76 years compared to 73 years for those undergoing SAVR. The baseline characteristics for patients in ViV-TAVR vs. redo-SAVR groups were comparable. At 30-days, the odds of all-cause mortality (OR 0.45, 95% CI 0.30–0.68, p =.0002), cardiovascular mortality (OR 0.44, 95% CI 0.26–0.73, p =.001) and major bleeding (OR 0.29, 95% CI 0.15–0.54, p =.0001) were significantly lower in patients undergoing ViV-TAVR compared to redo-SAVR. There were no significant differences in the odds of cerebrovascular accidents (OR 0.91, 95% CI 0.52–1.58, p =.74), myocardial infarction (OR 0.92, 95% CI 0.44–1.92, p =.83) and permanent pacemaker implantation (PPM) (OR 0.54, 95% CI 0.27–1.07, p =.08) between the two groups. During mid to long-term follow up (6-months to 5-years), there were no significant differences between ViV-TAVR and redo-SAVR for all-cause mortality, cardiovascular mortality and stroke. ViV-TAVR was, however, associated with higher risk of prosthesis-patient mismatch and greater transvalvular pressure gradient post-implantation. Conclusion: ViV-TAVR compared to redo-SAVR appears to be associated with significant improvement in short term mortality and major bleeding. For mid to long-term follow up, the outcomes were similar for both groups.

Original languageEnglish
Pages (from-to)940-947
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume98
Issue number5
DOIs
Publication statusPublished - 1 Nov 2021
Externally publishedYes

Keywords

  • aortic disease
  • aortic valve disease
  • surgery
  • transcatheter valve implantation
  • valvular

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