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Thorac Cardiovasc Surg 2019; 67(04): 243-250
DOI: 10.1055/s-0038-1668135
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Meta-analysis of Valve-in-Valve Transcatheter versus Redo Surgical Aortic Valve Replacement

Hisato Takagi
1   Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
,
Shohei Mitta
1   Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
,
Tomo Ando
2   Department of Cardiology, Detroit Medical Center, Detroit, United States
› Author Affiliations
Further Information

Publication History

15 February 2018

02 July 2018

Publication Date:
16 August 2018 (online)

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Abstract

Objective The objective of this study was to determine whether valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) is associated with better survival than redo surgical aortic valve replacement (SAVR) in patients with degenerated aortic valve bioprostheses, and we performed a meta-analysis of comparative studies.

Methods To identify all comparative studies of VIV-TAVI versus redo SAVR; MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched through October 2017. For each study, data regarding all-cause mortality in both the VIV-TAVI and redo SAVR groups were used to generate odds ratios (ORs). To assess selection bias, we generated ORs and (standardized) mean differences (MDs) for baseline characteristics. Study-specific estimates were combined in the random-effects model.

Results Of 446 potentially relevant articles screened initially, 6 reports of retrospective comparative studies enrolling a total of 498 patients were identified. Pooled analyses of baseline characteristics demonstrated no statistically significant differences in the proportion of women, patients with diabetes mellitus, patients with coronary artery disease, and patients with baseline New York Heart Association functional class of ≥III; baseline ejection fraction; and predicted mortality between the VIV-TAVI and redo SAVR groups. Patients in the VIV-TAVI group, however, were significantly older (MD, 4.20 years) and had undergone prior coronary artery bypass grafting more frequently (OR, 2.19) than those in the redo SAVR group. Main pooled analyses demonstrated no statistically significant differences in early (30 days or in-hospital) (OR, 0.91; p = 0.83) and midterm (180 days–3 years) all-cause mortalities (OR, 1.42; p = 0.21) between the VIV-TAVI and redo SAVR groups.

Conclusion In patients with degenerated aortic valve bioprostheses, especially elderly or high-risk patients, VIV-TAVI could be a safe, feasible alternative to redo SAVR. The lack of randomized data and differences in baseline characteristics in the present analysis emphasize the need for prospective randomized trials.

Keywords

degenerated aortic valve bioprostheses - meta-analysis - redo surgical aortic valve replacement - valve-in-valve transcatheter aortic valve implantation

Supplementary Material

 

  • References

  • 1 Webb JG, Mack MJ, White JM. , et al. Transcatheter aortic valve implantation within degenerated aortic surgical bioprostheses: PARTNER 2 Valve-in-Valve Registry. J Am Coll Cardiol 2017; 69 (18) 2253-2262
    CrossrefPubMedGoogle Scholar
  • 2 Kaneko T, Vassileva CM, Englum B. , et al. Contemporary outcomes of repeat aortic valve replacement: a benchmark for transcatheter valve-in-valve procedures. Ann Thorac Surg 2015; 100 (04) 1298-1304 , discussion 1304
    CrossrefPubMedGoogle Scholar
  • 3 Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50 (04) 1088-1101
    CrossrefPubMedGoogle Scholar
  • 4 Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315 (7109): 629-634
    CrossrefPubMedGoogle Scholar
  • 5 Ejiofor JI, Yammine M, Harloff MT. , et al. Reoperative surgical aortic valve replacement versus transcatheter valve-in-valve replacement for degenerated bioprosthetic aortic valves. Ann Thorac Surg 2016; 102 (05) 1452-1458
    CrossrefPubMedGoogle Scholar
  • 6 Erlebach M, Wottke M, Deutsch MA. , et al. Redo aortic valve surgery versus transcatheter valve-in-valve implantation for failing surgical bioprosthetic valves: consecutive patients in a single-center setting. J Thorac Dis 2015; 7 (09) 1494-1500
    Google Scholar
  • 7 Grubitzsch H, Zobel S, Christ T. , et al. Redo procedures for degenerated stentless aortic xenografts and the role of valve-in-valve transcatheter techniques. Eur J Cardiothorac Surg 2017; 51 (04) 653-659
    PubMedGoogle Scholar
  • 8 Santarpino G, Pietsch LE, Jessl J. , et al. Transcatheter aortic valve-in-valve implantation and sutureless aortic valve replacement: two strategies for one goal in redo patients. Minerva Cardioangiol 2016; 64 (06) 581-585
    PubMedGoogle Scholar
  • 9 Silaschi M, Wendler O, Seiffert M. , et al. Transcatheter valve-in-valve implantation versus redo surgical aortic valve replacement in patients with failed aortic bioprostheses. Interact Cardiovasc Thorac Surg 2017; 24 (01) 63-70
    CrossrefPubMedGoogle Scholar
  • 10 Spaziano M, Mylotte D, Thériault-Lauzier P. , et al. Transcatheter aortic valve implantation versus redo surgery for failing surgical aortic bioprostheses: a multicentre propensity score analysis. EuroIntervention 2017; 13 (10) 1149-1156
    CrossrefPubMedGoogle Scholar
  • 11 Kaneko T, Nauta F, Borstlap W, McGurk S, Rawn JD, Cohn LH. The “no-dissection” technique is safe for reoperative aortic valve replacement with a patent left internal thoracic artery graft. J Thorac Cardiovasc Surg 2012; 144 (05) 1036-1040
    CrossrefPubMedGoogle Scholar
  • 12 Elami A, Laks H, Merin G. Technique for reoperative median sternotomy in the presence of a patent left internal mammary artery graft. J Card Surg 1994; 9 (02) 123-127
    CrossrefPubMedGoogle Scholar
  • 13 Coltharp WH, Decker MD, Lea IV JW. , et al. Internal mammary artery graft at reoperation: risks, benefits, and methods of preservation. Ann Thorac Surg 1991; 52 (02) 225-228 , discussion 229
    CrossrefPubMedGoogle Scholar
  • 14 Ivert TS, Ekeström S, Péterffy A, Welti R. Coronary artery reoperations. Early and late results in 101 patients. Scand J Thorac Cardiovasc Surg 1988; 22 (02) 111-118
    PubMedGoogle Scholar
  • 15 Dvir D, Webb J, Brecker S. , et al. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the Global Valve-in-Valve Registry. Circulation 2012; 126 (19) 2335-2344
    CrossrefPubMedGoogle Scholar
  • 16 Simonato M, Webb J, Kornowski R. , et al. Transcatheter replacement of failed bioprosthetic valves: large multicenter assessment of the effect of implantation depth on hemodynamics after aortic valve-in-valve. Circ Cardiovasc Interv 2016; 9 (06) e003651
    PubMedGoogle Scholar
  • 17 Azadani AN, Jaussaud N, Matthews PB. , et al. Valve-in-valve implantation using a novel supravalvular transcatheter aortic valve: proof of concept. Ann Thorac Surg 2009; 88 (06) 1864-1869
    CrossrefPubMedGoogle Scholar
  • 18 Saxon JT, Allen KB, Cohen DJ, Chhatriwalla AK. Bioprosthetic valve fracture during valve-in-valve TAVR: bench to bedside. Interv Cardiol 2018; 13 (01) 20-26
    PubMedGoogle Scholar
  • 19 Chhatriwalla AK, Allen KB, Saxon JT. , et al. Bioprosthetic valve fracture improves the hemodynamic results of valve-in-valve transcatheter aortic valve replacement. Circ Cardiovasc Interv 2017; 10 (07) e005216
    PubMedGoogle Scholar
  • 20 Nielsen-Kudsk JE, Andersen A, Therkelsen CJ. , et al. High-pressure balloon fracturing of small dysfunctional Mitroflow bioprostheses facilitates transcatheter aortic valve-in-valve implantation. EuroIntervention 2017; 13 (09) e1020-e1025
    CrossrefPubMedGoogle Scholar