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Meta-analysis comparing valve-in-valve TAVR and redo-SAVR in patients with degenerated bioprosthetic aortic valve.

Saleem S, Ullah W, Syed MA, Megaly M, Thalambedu N, Younas S, Zahid S, Alam M, Virani SS, Verma DR, Abdul-Waheed M, Fischman DL. Meta-analysis comparing valve-in-valve TAVR and redo-SAVR in patients with degenerated bioprosthetic aortic valve. Catheterization and Cardiovascular Interventions : Official Journal of The Society For Cardiac Angiography & Interventions. 2021 Nov 1; 98(5):940-947.

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INTRODUCTION: The comparative efficacy and safety of valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) and redo-surgical AVR (redo-SAVR) in patients with degenerated bioprosthetic aortic valves remain unknown. METHOD: Digital databases were searched to identify relevant articles. Unadjusted odds ratios for dichotomous outcomes were calculated using a random effect model. A total of 11 studies comprising 8326 patients (ViV-TAVR  =  4083 and redo-SAVR  =  4243) were included. RESULTS: The mean age of patients undergoing ViV-TAVR was older, 76?years compared to 73?years for those undergoing SAVR. The baseline characteristics for patients in ViV-TAVR vs. redo-SAVR groups were comparable. At 30-days, the odds of all-cause mortality (OR 0.45, 95% CI 0.30-0.68, p  =  .0002), cardiovascular mortality (OR 0.44, 95% CI 0.26-0.73, p  =  .001) and major bleeding (OR 0.29, 95% CI 0.15-0.54, p  =  .0001) were significantly lower in patients undergoing ViV-TAVR compared to redo-SAVR. There were no significant differences in the odds of cerebrovascular accidents (OR 0.91, 95% CI 0.52-1.58, p  =  .74), myocardial infarction (OR 0.92, 95% CI 0.44-1.92, p  =  .83) and permanent pacemaker implantation (PPM) (OR 0.54, 95% CI 0.27-1.07, p  =  .08) between the two groups. During mid to long-term follow up (6-months to 5-years), there were no significant differences between ViV-TAVR and redo-SAVR for all-cause mortality, cardiovascular mortality and stroke. ViV-TAVR was, however, associated with higher risk of prosthesis-patient mismatch and greater transvalvular pressure gradient post-implantation. CONCLUSION: ViV-TAVR compared to redo-SAVR appears to be associated with significant improvement in short term mortality and major bleeding. For mid to long-term follow up, the outcomes were similar for both groups.

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