Transcatheter Replacement of Transcatheter Versus Surgically Implanted Aortic Valve Bioprostheses

Uri Landes; Janarthanan Sathananthan; Guy Witberg; Ole De Backer; Lars Sondergaard; Mohamed Abdel-Wahab; David Holzhey; Won-Keun Kim; Christian Hamm; Nicola Buzzatti; Matteo Montorfano; Sebastian Ludwig; Lenard Conradi; Moritz Seiffert; Mayra Guerrero; Abdallah El Sabbagh; Josep Rodés-Cabau; Leonardo Guimaraes; Pablo Codner; Taishi Okuno; Thomas Pilgrim; Claudia Fiorina; Antonio Colombo; Antonio Mangieri; Helene Eltchaninoff; Luis Nombela-Franco; Maarten P H Van Wiechen; Nicolas M Van Mieghem; Didier Tchétché; Wolfgang H Schoels; Matthias Kullmer; Corrado Tamburino; Jan-Malte Sinning; Baravan Al-Kassou; Gidon Y Perlman; Haim Danenberg; Alfonso Ielasi; Chiara Fraccaro; Giuseppe Tarantini; Federico De Marco; Simon R Redwood; John C Lisko; Vasilis C Babaliaros; Mika Laine; Roberto Nerla; Fausto Castriota; Ariel Finkelstein; Itamar Loewenstein; Amnon Eitan; Ronen Jaffe

doi:10.1016/j.jacc.2020.10.053

Transcatheter Replacement of Transcatheter Versus Surgically Implanted Aortic Valve Bioprostheses

Uri Landes, Janarthanan Sathananthan, Guy Witberg, Ole De Backer, Lars Sondergaard, Mohamed Abdel-Wahab, David Holzhey, Won-Keun Kim, Christian Hamm, Nicola Buzzatti, Matteo Montorfano, Sebastian Ludwig, Lenard Conradi, Moritz Seiffert, Mayra Guerrero, Abdallah El Sabbagh, Josep Rodés-Cabau, Leonardo Guimaraes, Pablo Codner, Taishi OkunoThomas Pilgrim, Claudia Fiorina, Antonio Colombo, Antonio Mangieri, Helene Eltchaninoff, Luis Nombela-Franco, Maarten P H Van Wiechen, Nicolas M Van Mieghem, Didier Tchétché, Wolfgang H Schoels, Matthias Kullmer, Corrado Tamburino, Jan-Malte Sinning, Baravan Al-Kassou, Gidon Y Perlman, Haim Danenberg, Alfonso Ielasi, Chiara Fraccaro, Giuseppe Tarantini, Federico De Marco, Simon R Redwood, John C Lisko, Vasilis C Babaliaros, Mika Laine, Roberto Nerla, Fausto Castriota, Ariel Finkelstein, Itamar Loewenstein, Amnon Eitan, Ronen Jaffe

Afdeling for Hjertesygdomme

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.

Originalsprog	Engelsk
Tidsskrift	Journal of the American College of Cardiology
Vol/bind	77
Udgave nummer	1
Sider (fra-til)	1-14
Antal sider	14
ISSN	0735-1097
DOI	https://doi.org/10.1016/j.jacc.2020.10.053
Status	Udgivet - 5 jan. 2021

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10.1016/j.jacc.2020.10.053

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Landes, U., Sathananthan, J., Witberg, G., De Backer, O., Sondergaard, L., Abdel-Wahab, M., Holzhey, D., Kim, W.-K., Hamm, C., Buzzatti, N., Montorfano, M., Ludwig, S., Conradi, L., Seiffert, M., Guerrero, M., El Sabbagh, A., Rodés-Cabau, J., Guimaraes, L., Codner, P., ... Jaffe, R. (2021). Transcatheter Replacement of Transcatheter Versus Surgically Implanted Aortic Valve Bioprostheses. Journal of the American College of Cardiology, 77(1), 1-14. https://doi.org/10.1016/j.jacc.2020.10.053

Landes, U, Sathananthan, J, Witberg, G, De Backer, O , Sondergaard, L, Abdel-Wahab, M, Holzhey, D, Kim, W-K, Hamm, C, Buzzatti, N, Montorfano, M, Ludwig, S, Conradi, L, Seiffert, M, Guerrero, M, El Sabbagh, A, Rodés-Cabau, J, Guimaraes, L, Codner, P, Okuno, T, Pilgrim, T, Fiorina, C, Colombo, A, Mangieri, A, Eltchaninoff, H, Nombela-Franco, L, Van Wiechen, MPH, Van Mieghem, NM, Tchétché, D, Schoels, WH, Kullmer, M, Tamburino, C, Sinning, J-M, Al-Kassou, B, Perlman, GY, Danenberg, H, Ielasi, A, Fraccaro, C, Tarantini, G, De Marco, F, Redwood, SR, Lisko, JC, Babaliaros, VC, Laine, M, Nerla, R, Castriota, F, Finkelstein, A, Loewenstein, I, Eitan, A & Jaffe, R 2021, 'Transcatheter Replacement of Transcatheter Versus Surgically Implanted Aortic Valve Bioprostheses', Journal of the American College of Cardiology, bind 77, nr. 1, s. 1-14. https://doi.org/10.1016/j.jacc.2020.10.053

@article{e8707593310e4926991713c6bbabbb3f,

title = "Transcatheter Replacement of Transcatheter Versus Surgically Implanted Aortic Valve Bioprostheses",

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 = "Acute Kidney Injury/epidemiology, Aged, Aged, 80 and over, Aortic Valve Insufficiency/epidemiology, Aortic Valve Stenosis/mortality, Bioprosthesis, Conversion to Open Surgery/statistics & numerical data, Coronary Occlusion/epidemiology, Female, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation, Hemorrhage/epidemiology, Humans, Male, Pacemaker, Artificial/statistics & numerical data, Patient Safety, Propensity Score, Registries, Transcatheter Aortic Valve Replacement",

author = "Uri Landes and Janarthanan Sathananthan and Guy Witberg and {De Backer}, Ole and Lars Sondergaard and Mohamed Abdel-Wahab and David Holzhey and Won-Keun Kim and Christian Hamm and Nicola Buzzatti and Matteo Montorfano and Sebastian Ludwig and Lenard Conradi and Moritz Seiffert and Mayra Guerrero and {El Sabbagh}, Abdallah and Josep Rod{\'e}s-Cabau and Leonardo Guimaraes and Pablo Codner and Taishi Okuno and Thomas Pilgrim and Claudia Fiorina and Antonio Colombo and Antonio Mangieri and Helene Eltchaninoff and Luis Nombela-Franco and {Van Wiechen}, {Maarten P H} and {Van Mieghem}, {Nicolas M} and Didier Tch{\'e}tch{\'e} and Schoels, {Wolfgang H} and Matthias Kullmer and Corrado Tamburino and Jan-Malte Sinning and Baravan Al-Kassou and Perlman, {Gidon Y} and Haim Danenberg and Alfonso Ielasi and Chiara Fraccaro and Giuseppe Tarantini and {De Marco}, Federico and Redwood, {Simon R} and Lisko, {John C} and Babaliaros, {Vasilis C} and Mika Laine and Roberto Nerla and Fausto Castriota and Ariel Finkelstein and Itamar Loewenstein and Amnon Eitan and Ronen Jaffe",

year = "2021",

month = jan,

day = "5",

doi = "10.1016/j.jacc.2020.10.053",

language = "English",

volume = "77",

pages = "1--14",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Inc",

number = "1",

}

TY - JOUR

T1 - Transcatheter Replacement of Transcatheter Versus Surgically Implanted Aortic Valve Bioprostheses

AU - Landes, Uri

AU - Sathananthan, Janarthanan

AU - Witberg, Guy

AU - De Backer, Ole

AU - Sondergaard, Lars

AU - Abdel-Wahab, Mohamed

AU - Holzhey, David

AU - Kim, Won-Keun

AU - Hamm, Christian

AU - Buzzatti, Nicola

AU - Montorfano, Matteo

AU - Ludwig, Sebastian

AU - Conradi, Lenard

AU - Seiffert, Moritz

AU - Guerrero, Mayra

AU - El Sabbagh, Abdallah

AU - Rodés-Cabau, Josep

AU - Guimaraes, Leonardo

AU - Codner, Pablo

AU - Okuno, Taishi

AU - Pilgrim, Thomas

AU - Fiorina, Claudia

AU - Colombo, Antonio

AU - Mangieri, Antonio

AU - Eltchaninoff, Helene

AU - Nombela-Franco, Luis

AU - Van Wiechen, Maarten P H

AU - Van Mieghem, Nicolas M

AU - Tchétché, Didier

AU - Schoels, Wolfgang H

AU - Kullmer, Matthias

AU - Tamburino, Corrado

AU - Sinning, Jan-Malte

AU - Al-Kassou, Baravan

AU - Perlman, Gidon Y

AU - Danenberg, Haim

AU - Ielasi, Alfonso

AU - Fraccaro, Chiara

AU - Tarantini, Giuseppe

AU - De Marco, Federico

AU - Redwood, Simon R

AU - Lisko, John C

AU - Babaliaros, Vasilis C

AU - Laine, Mika

AU - Nerla, Roberto

AU - Castriota, Fausto

AU - Finkelstein, Ariel

AU - Loewenstein, Itamar

AU - Eitan, Amnon

AU - Jaffe, Ronen

PY - 2021/1/5

Y1 - 2021/1/5

N2 - 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.

AB - 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.

KW - Acute Kidney Injury/epidemiology

KW - Aged

KW - Aged, 80 and over

KW - Aortic Valve Insufficiency/epidemiology

KW - Aortic Valve Stenosis/mortality

KW - Bioprosthesis

KW - Conversion to Open Surgery/statistics & numerical data

KW - Coronary Occlusion/epidemiology

KW - Female

KW - Heart Valve Prosthesis

KW - Heart Valve Prosthesis Implantation

KW - Hemorrhage/epidemiology

KW - Humans

KW - Male

KW - Pacemaker, Artificial/statistics & numerical data

KW - Patient Safety

KW - Propensity Score

KW - Registries

KW - Transcatheter Aortic Valve Replacement

UR - http://www.scopus.com/inward/record.url?scp=85098076120&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2020.10.053

DO - 10.1016/j.jacc.2020.10.053

M3 - Journal article

C2 - 33413929

SN - 0735-1097

VL - 77

SP - 1

EP - 14

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 1

ER -

Transcatheter Replacement of Transcatheter Versus Surgically Implanted Aortic Valve Bioprostheses

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