For a study, the researchers sought to look at the progress of early and midterm results after ViV and standard redo-surgical aortic valve replacement (SAVR) during the last 2 decades because valve-in-valve (ViV) transcatheter aortic valve implantation was still an emerging procedure. Patients of more than or equal to 60 treated at the research center for failing bioprosthetic aortic valves were retrospectively screened in hospital databases. According to the valve academic research consortium-2 (VARC-2) definitions, clinical and follow-up variables were compared between patients who received ViV or redo-SAVR. The baseline differences across groups were taken into account while comparing outcome metrics. Between June 2002 and April 2020, 209 ViV patients and 65 redo-SAVR patients met the criteria for inclusion. In 30 days (ViV 3.8%, SAVR 3.1%, p=0.778) or 6-month mortality (ViV 14.0%, SAVR 7.5%, p=0.283), no significant differences were identified. Patients with ViV were more likely to reach the 30-day VARC-2 combined safety endpoint (79.2% vs 61.5%, odds ratio [OR] 2.540, p=0.023) because they had a less acute renal injury (stage II or III) and life-threatening bleeding. Because of a larger incidence of postprocedural transvalvular gradients of more than 20 mm Hg, patients with ViV had a lower chance of achieving clinical efficacy (68.3% vs 84.6%, OR 0.408, p=0.041) and device success (79.9% vs 92.3%, OR 0.311, p=0.040). However, in ViV cases, VARC-2 clinical efficacy and device success rates have steadily increased over the last decade. ViV and SAVR were associated with identical acute mortality in the single-center cohort and varied favorable and unfavorable outcome patterns. Over the years, the outcomes of ViV surgeries have steadily improved.
Source:www.ajconline.org/article/S0002-9149(22)00122-9/fulltext
