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Meta-Analysis
. 2021 Jan 25;14(2):211-220.
doi: 10.1016/j.jcin.2020.10.020.

Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo Surgical Aortic Valve Replacement: An Updated Meta-Analysis

Michel Pompeu B O Sá  1 , Jef Van den Eynde  2 , Matheus Simonato  3 , Luiz Rafael P Cavalcanti  4 , Ilias P Doulamis  5 , Viktoria Weixler  6 , Polydoros N Kampaktsis  7 , Michele Gallo  8 , Pietro L Laforgia  9 , Konstantin Zhigalov  10 , Arjang Ruhparwar  10 , Alexander Weymann  10 , Philippe Pibarot  11 , Marie-Annick Clavel  11
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Free article
Meta-Analysis

Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo Surgical Aortic Valve Replacement: An Updated Meta-Analysis

Michel Pompeu B O Sá et al. JACC Cardiovasc Interv. .
Free article

Erratum in

  • Correction.
    [No authors listed] [No authors listed] JACC Cardiovasc Interv. 2021 Apr 26;14(8):937-939. doi: 10.1016/j.jcin.2021.03.056. JACC Cardiovasc Interv. 2021. PMID: 33888243 No abstract available.

Abstract

Objectives: The aim of this study was to evaluate early results of valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) versus redo surgical aortic valve replacement (SAVR) for structural valve degeneration (SVD).

Background: ViV TAVR has been increasingly used for SVD, but it remains unknown whether it produces better or at least comparable results as redo SAVR.

Methods: Observational studies comparing ViV TAVR and redo SAVR were identified in a systematic search of published research. Random-effects meta-analysis was performed, comparing clinical outcomes between the 2 groups.

Results: Twelve publications including a total of 16,207 patients (ViV TAVR, n = 8,048; redo SAVR, n = 8,159) were included from studies published from 2015 to 2020. In the pooled analysis, ViV TAVR was associated with lower rates of 30-day mortality overall (odds ratio [OR]: 0.53; 95% confidence interval [CI]: 0.32 to 0.87; p = 0.017) and for matched populations (OR: 0.419; 95% CI: 0.278 to 0.632; p = 0.003), stroke (OR: 0.65; 95% CI: 0.55 to 0.76; p < 0.001), permanent pacemaker implantation (OR: 0.73; 95% CI: 0.22 to 2.43; p = 0.536), and major bleeding (OR: 0.49; 95% CI: 0.26 to 0.93; p = 0.034), as well as with shorter hospital stay (OR: -3.30; 95% CI: -4.52 to -2.08; p < 0.001). In contrast, ViV TAVR was associated with higher rates of myocardial infarction (OR: 1.50; 95% CI: 1.01 to 2.23; p = 0.045) and severe patient-prosthesis mismatch (OR: 4.63; 95% CI: 3.05 to 7.03; p < 0.001). The search revealed an important lack of comparative studies with long-term results.

Conclusions: ViV TAVR is a valuable option in the treatment of patients with SVD because of its lower incidence of post-operative complications and better early survival compared with redo SAVR. However, ViV TAVR is associated with higher rates of myocardial infarction and severe patient-prosthesis mismatch.

Keywords: aortic valve; meta-analysis; structural valve degeneration; surgical aortic valve replacement; transcatheter aortic valve replacement.

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Conflict of interest statement

Author Disclosures Dr. Pibarot has echocardiography Core Laboratory contracts with Edwards Lifesciences, for which he receives no direct compensation. Dr. Clavel has computed tomography Core Laboratory contract with Edwards Lifesciences, for which she receives no direct compensation and received research grant from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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