Is V-in-V the Treatment of Choice in Cases of Failed Biological Prosthesis?

Courtesy of Dr. Carlos Fava.

The treatment of choice for failed biological aortic prostheses has always been redo surgery (RS), with mortality rates approximately higher than for the first surgery.

Nowadays, we have the chance to conduct valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI); however, while different analyses report great benefit derived from it, we still have very little information comparing both strategies.

Researchers analyzed 214 patients who underwent ViV TAVI and 344 who underwent RS.

Populations were very different: patients who underwent ViV TAVI were older and had more comorbidities, with increased risk. Consequently, subjects were propensity matched on 27 variables, which yielded 131 comparable pairs.

The time from initial surgical aortic valve replacement to ViV was 11.3 years, while it was 8.6 years to RS.

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After a 30-day follow-up, mortality was lower among subjects in the V-in-V group (absolute risk difference: -7.5%; 95% confidence interval -12.6% to -2.3%). Additionally, the rates of blood transfusion and permanent pacemaker implantation were lower, and so was the number of hospitalization days (7 vs. 14 days; p < 0.001).

After 5 years of follow-up, the rates of survival were better for subjects who underwent ViV (76.8% vs. 66.8%; hazard ratio: 0.55; 95% confidence interval: 0.30 to 0.99; p = 0.04). Furthermore, there were no differences as regards hospital readmissions, major adverse cardiac events (MACE), and stroke.

Conclusion

ViV TAVI was associated with lower early mortality, morbidity, and length of hospital stay, and with increased survival compared with RS. Perhaps, it should be the treatment of choice in cases of failed biological prosthesis.

Courtesy of Dr. Carlos Fava.

Original title: Transcatheter ViV Versus Redo Surgical AVR for the Management of Failed Biological Prosthesis Early and Late Outcomes in a Propensity-Matched Cohort.

Reference: Derrick Y. Tam et al. J Am Coll Cardiol Intv 2020;13:765-74

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