Transcatheter valve-in-valve implantation (ViV-TAVI) has evolved as an alternative
to redo surgical valve replacement (redo-SAVR) for high-risk patients with aortic
bioprosthetic valve (BPV) dysfunction. The differences in procedural success and outcomes
in a large number of patients who underwent ViV-TAVI compared with redo-SAVR for aortic
BPV dysfunction are not known. We conducted a meta-analysis of the previously reported
studies to determine outcomes after ViV-TAVI and redo-SAVR. PubMed, MEDLINE, and Google
Scholar databases were searched for studies that reported comparative outcomes of
patients who underwent either ViV-TAVI or redo-SAVR. Four observational studies met
the inclusion criteria, with a total of 489 patients, 227 of whom underwent ViV-TAVI
and 262 underwent redo-SAVR. Thirty-day mortality was similar in 2 groups (5% vs 4%;
odds ratio [OR] = 1.08, 95% confidence interval [CI] = 0.44 to 2.62) despite the higher
operative risk in the ViV-TAVI cohort as evidenced by significantly higher EuroSCORE
I or II. There were similar rates of stroke (2% vs 2%; OR = 1.00, 95% CI = 0.28 to
3.59), myocardial infarction (2% vs 1%; OR = 1.08, 95% CI = 0.27 to 4.33), and acute
kidney injury requiring dialysis (7% vs 10%; OR = 0.80, 95% CI = 0.36 to 0.1.77) between
2 groups but a lower rate of permanent pacemaker implantation in the ViV-TAVI group
(9% vs 15%; OR = 0.44, 95% CI = 0.24 to 0.81). This meta-analysis of nonrandomized
studies with modest number of patients suggested that ViV-TAVI had similar 30-day
survival compared with redo-SAVR for aortic BPV dysfunction.
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Article info
Publication history
Published online: April 19, 2018
Accepted:
February 26,
2018
Received:
November 4,
2017
Footnotes
See page 1599 for disclosure information.
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© 2018 Elsevier Inc. All rights reserved.
