Valve-in-valve TAVR confers short-term benefits in failed surgical AVR
Among patients with a failed surgical aortic valve, valve-in-valve transcatheter aortic valve replacement was linked to better short-term outcomes than redo surgical AVR, researchers reported.
Long-term major CV outcomes were similar between the approaches, but valve-in-valve TAVR was linked to more HF hospitalization and permanent pacemaker implantation, according to the study published in the Journal of the American College of Cardiology.
From a cohort of 4,327 patients from a French administrative hospital-discharge database who had an aortic bioprosthesis failure treated with valve-in-valve TAVR or redo surgical AVR between 2010 and 2019, the researched analyzed 717 pairs with one from each group that were matched based on baseline characteristics (mean age, 75 years; 58% men in surgery group; 56% men in TAVR group).
At 30 days, the composite outcome of all-cause mortality, all-cause stroke, MI or major or life-threatening bleeding occurred less often in the TAVR group compared with the surgery group (OR = 0.62; 95% CI, 0.44-0.88), Pierre Deharo, PhD, from the cardiology department at CHU Timone, Marseille, France, and colleagues wrote.
At a median of 516 days of follow-up, the composite outcome of CV death, all-cause stroke, MI or rehospitalization did not differ between the groups (OR = 1.18; 95% CI, 0.99-1.41), according to the researchers.
HF hospitalization occurred more often in the valve-in-valve TAVR group (OR = 1.37; 95% CI, 1.1-1.71), as did permanent pacemaker implantation (incidence rate ratio = 2.66; 95% CI, 2.05-3.47), Deharo and colleagues wrote.
All-cause mortality and CV mortality in the valve-in-valve TAVR group were lower from 2016 to 2019 vs. from 2010 to 2015 (P for interaction < .05), they wrote.
In a related editorial, Michael A. Borger, MD, PhD, from the University Clinic for Cardiac Surgery at Leipzig Heart Center, Leipzig, Germany, and colleagues wrote that a randomized trial is necessary.
“Whether there is enough clinical equipoise within the cardiovascular community to perform a randomized trial comparing [redo surgical AVR with valve-in-valve TAVR] with adequate follow-up is arguable,” they wrote. “However, the available data suggest that we
would serve our patients best with such a randomized trial, particularly in younger, lower-risk patients presenting with failed aortic bioprostheses.”