Forskning ved Københavns Universitet - Københavns Universitet


Transcatheter aortic valve implantation versus redo surgery for failing surgical aortic bioprostheses: a multicentre propensity score analysis

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Marco Spaziano
  • Darren Mylotte
  • Pascal Thériault-Lauzier
  • Ole De Backer
  • Søndergaard, Lars
  • Johan Bosmans
  • Nicolas Debry
  • Thomas Modine
  • Marco Barbanti
  • Corrado Tamburino
  • Jan-Malte Sinning
  • Eberhard Grube
  • Georg Nickenig
  • Fritz Mellert
  • Sabine Bleiziffer
  • Rüdiger Lange
  • Benoit de Varennes
  • Kevin Lachapelle
  • Giuseppe Martucci
  • Nicolo Piazza

AIMS: Transcatheter aortic valve implantation for a failing surgical bioprosthesis (TAV-in-SAV) has become an alternative for patients at high risk for redo surgical aortic valve replacement (redo-SAVR). Comparisons between these approaches are non-existent. This study aimed to compare clinical and echocardiographic outcomes of patients undergoing TAV-in-SAV versus redo-SAVR after accounting for baseline differences by propensity score matching.

METHODS AND RESULTS: Patients from seven centres in Europe and Canada who had undergone either TAV-in-SAV (n=79) or redo-SAVR (n=126) were identified. Significant independent predictors used for propensity scoring were age, NYHA functional class, number of prior cardiac surgeries, urgent procedure, pulmonary hypertension, and COPD grade. Using a calliper range of ±0.05, a total of 78 well-matched patient pairs were found. All-cause mortality was similar between groups at 30 days (6.4% redo-SAVR vs. 3.9% TAV-in-SAV; p=0.49) and one year (13.1% redo-SAVR vs. 12.3% TAV-in-SAV; p=0.80). Both groups also showed similar incidences of stroke (0% redo-SAVR vs. 1.3% TAV-in-SAV; p=1.0) and new pacemaker implantation (10.3% redo-SAVR vs. 10.3% TAV-in-SAV; p=1.0). The incidence of acute kidney injury requiring dialysis was numerically lower in the TAV-in-SAV group (11.5% redo-SAVR vs. 3.8% TAV-in-SAV; p=0.13). The TAV-in-SAV group had a significantly shorter median total hospital stay (12 days redo-SAVR vs. 9 days TAV-in-SAV; p=0.001).

CONCLUSIONS: Patients with aortic bioprosthesis failure treated with either redo-SAVR or TAV-in-SAV have similar 30-day and one-year clinical outcomes.

TidsskriftEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
Udgave nummer10
Sider (fra-til)1149-1156
Antal sider8
StatusUdgivet - 20 nov. 2017

ID: 195552475