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Comparative Study
. 2021 Jan 5;77(1):1-14.
doi: 10.1016/j.jacc.2020.10.053.

Transcatheter Replacement of Transcatheter Versus Surgically Implanted Aortic Valve Bioprostheses

Uri Landes  1 , Janarthanan Sathananthan  2 , Guy Witberg  3 , Ole De Backer  4 , Lars Sondergaard  4 , Mohamed Abdel-Wahab  5 , David Holzhey  5 , Won-Keun Kim  6 , Christian Hamm  6 , Nicola Buzzatti  7 , Matteo Montorfano  7 , Sebastian Ludwig  8 , Lenard Conradi  8 , Moritz Seiffert  8 , Mayra Guerrero  9 , Abdallah El Sabbagh  9 , Josep Rodés-Cabau  10 , Leonardo Guimaraes  10 , Pablo Codner  3 , Taishi Okuno  11 , Thomas Pilgrim  11 , Claudia Fiorina  12 , Antonio Colombo  13 , Antonio Mangieri  13 , Helene Eltchaninoff  14 , Luis Nombela-Franco  15 , Maarten P H Van Wiechen  16 , Nicolas M Van Mieghem  16 , Didier Tchétché  17 , Wolfgang H Schoels  18 , Matthias Kullmer  18 , Corrado Tamburino  19 , Jan-Malte Sinning  20 , Baravan Al-Kassou  20 , Gidon Y Perlman  21 , Haim Danenberg  21 , Alfonso Ielasi  22 , Chiara Fraccaro  23 , Giuseppe Tarantini  23 , Federico De Marco  24 , Simon R Redwood  25 , John C Lisko  26 , Vasilis C Babaliaros  26 , Mika Laine  27 , Roberto Nerla  28 , Fausto Castriota  28 , Ariel Finkelstein  29 , Itamar Loewenstein  29 , Amnon Eitan  30 , Ronen Jaffe  30 , Philipp Ruile  31 , Franz J Neumann  31 , Nicolo Piazza  32 , Hind Alosaimi  32 , Horst Sievert  33 , Kolja Sievert  33 , Marco Russo  34 , Martin Andreas  34 , Matjaz Bunc  35 , Azeem Latib  36 , Rebecca Godfrey  37 , David Hildick-Smith  37 , Ming-Yu A Chuang  2 , Philipp Blanke  2 , Jonathon Leipsic  2 , David A Wood  2 , Tamim M Nazif  38 , Susheel Kodali  38 , Marco Barbanti  19 , Ran Kornowski  3 , Martin B Leon  38 , John G Webb  39
Affiliations
Free article
Comparative Study

Transcatheter Replacement of Transcatheter Versus Surgically Implanted Aortic Valve Bioprostheses

Uri Landes et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR) are now both used to treat aortic stenosis in patients in whom life expectancy may exceed valve durability. The choice of initial bioprosthesis should therefore consider the relative safety and efficacy of potential subsequent interventions.

Objectives: The aim of this study was to compare TAVR in failed transcatheter aortic valves (TAVs) versus surgical aortic valves (SAVs).

Methods: Data were collected on 434 TAV-in-TAV and 624 TAV-in-SAV consecutive procedures performed at centers participating in the Redo-TAVR international registry. Propensity score matching was applied, and 330 matched (165:165) patients were analyzed. Principal endpoints were procedural success, procedural safety, and mortality at 30 days and 1 year.

Results: For TAV-in-TAV versus TAV-in-SAV, procedural success was observed in 120 (72.7%) versus 103 (62.4%) patients (p = 0.045), driven by a numerically lower frequency of residual high valve gradient (p = 0.095), ectopic valve deployment (p = 0.081), coronary obstruction (p = 0.091), and conversion to open heart surgery (p = 0.082). Procedural safety was achieved in 116 (70.3%) versus 119 (72.1%) patients (p = 0.715). Mortality at 30 days was 5 (3%) after TAV-in-TAV and 7 (4.4%) after TAV-in-SAV (p = 0.570). At 1 year, mortality was 12 (11.9%) and 10 (10.2%), respectively (p = 0.633). Aortic valve area was larger (1.55 ± 0.5 cm2 vs. 1.37 ± 0.5 cm2; p = 0.040), and the mean residual gradient was lower (12.6 ± 5.2 mm Hg vs. 14.9 ± 5.2 mm Hg; p = 0.011) after TAV-in-TAV. The rate of moderate or greater residual aortic regurgitation was similar, but mild aortic regurgitation was more frequent after TAV-in-TAV (p = 0.003).

Conclusions: In propensity score-matched cohorts of TAV-in-TAV versus TAV-in-SAV patients, TAV-in-TAV was associated with higher procedural success and similar procedural safety or mortality.

Keywords: Redo-TAVR; TAVR; surgical aortic valve; transcatheter aortic valve; valve-in-valve.

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Conflict of interest statement

Author Disclosures Dr. Webb is a consultant to and has received research funding from Edwards Lifesciences, Abbott Vascular, Boston Scientific, and ViVitro Labs. Dr. Kim has received proctor or speaker fees from Boston Scientific, Abbott, Edwards Lifesciences, and Medtronic. Dr. Barbanti is a consultant for Edwards; and is an Advisory Board member for Biotronik. Dr. Sondergaard has received consultant fees and institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, and Symetis. Dr. Redwood is a proctor for and has received lecture fees from Edwards. Dr. Hamm is an Advisory Board member for Medtronic. Dr. Sinning has received speaker honoraria and research grants from Medtronic, Boston Scientific, and Edwards Lifesciences. Dr. Wood is a consultant to and has received research funding from Edwards Lifesciences, Abbott Vascular, and Boston Scientific. Dr. Sathananthan is a consultant to Edwards Lifesciences. Dr. Schofer has received speaker fees and travel compensation from Boston Scientific; and has received travel compensation from Edwards Lifesciences and Abbott/St. Jude Medical. Dr. Leipsic is a consultant to Circle CVI and Edwards Lifesciences; and provides institutional core laboratory services to Edwards Lifesciences, Abbott, Medtronic, and Neovasc. Dr. Andreas is a proctor for Edwards and Abbott; and is an Advisory Board member for Medtronic. Dr. Guerrero has received research grant support from Abbott Vascular and Edwards Lifesciences. Dr. Castriota is a proctor for Medtronic and Boston Scientific. Dr. Kodali has received research grants from Edwards Lifesciences, Medtronic, and Boston Scientific; has received grants and personal fees from Abbott Vascular and JenaValve; has received personal fees from Meril Lifesciences; has received personal fees from and holds equity in Admedus; and holds equity in Supira, Microinterventional Devices, Dura Biotech, and Thubrikar Aortic Valve. Dr. Conradi is a consultant to Edwards Lifesciences, Medtronic, Boston Scientific, Abbott, Neovasc, and JenaValve. Dr. Nazif has received consulting fees or honoraria from Edwards Lifesciences, Medtronic, Boston Scientific, Biotrace, and Baylis Medical; and has received consulting fees from and holds equity in Venus Medtech. Dr. Pilgrim has received research grants from Boston Scientific, Edwards Lifesciences, and Biotronik; and has received speaker fees from Boston Scientific and Biotronik. Dr. Babaliaros is a consultant to Edwards Lifesciences; and holds equity in Transmural Systems. Dr. Van Mieghem has received institutional research grants and consulting fees from Abbott, Boston Scientific, Medtronic, Daiichi-Sankyo, and PulseCath; and has received institutional research grant support from Edwards Lifesciences. Dr. Latib has received institutional research or grant support from Abbott, Boston Scientific, Medtronic, and Edwards Lifesciences; and has received personal consulting honoraria from Abbott, Edwards Lifesciences, and Medtronic. Dr. Hildick-Smith is a proctor and adviser to Boston Scientific, Medtronic, and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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