Transcatheter Aortic Valve Replacement of Failed Surgically Implanted Bioprostheses: The STS/ACC Registry

E. Murat Tuzcu, Samir R. Kapadia, Sreekanth Vemulapalli, John D. Carroll, David Holmes, Michael J. Mack, Vinod H. Thourani, Frederick L. Grover, J. Matthew Brennan, Rakesh M. Suri, David Dai, Lars G. Svensson

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has been shown to be feasible, yet the safety and efficacy in relation to native valve (NV) TAVR are not known. Objectives: This study sought to evaluate the safety and effectiveness of ViV TAVR for failed surgical aortic valve replacement (SAVR) by comparing it with the benchmark of NV TAVR. Methods: Patients who underwent ViV-TAVR (n = 1,150) were matched 1:2 (on sex, high or extreme risk, hostile chest or porcelain aorta, 5-m-walk time, and Society of Thoracic Surgeons Predicted Risk of Mortality for reoperation) to patients undergoing NV-TAVR (n = 2,259). Baseline characteristics, procedural data, and in-hospital outcomes were obtained from the Transcatheter Valve Therapy Registry. The 30-day and 1-year outcomes were obtained from linked Medicare administrative claims data. Results: Unadjusted analysis revealed lower 30-day mortality (2.9% vs. 4.8%; p < 0.001), stroke (1.7% vs. 3.0%; p = 0.003), and heart failure hospitalizations (2.4% vs. 4.6%; p < 0.001) in the ViV-TAVR compared with NV-TAVR group. Adjusted analysis revealed lower 30-day mortality (hazard ratio: 0.503; 95% confidence interval: 0.302 to 0.839; p = 0.008), lower 1-year mortality (hazard ratio: 0.653; 95% confidence interval: 0.505 to 0.844; p = 0.001), and hospitalization for heart failure (hazard ratio: 0.685; 95% confidence interval: 0.500 to 0.939; p = 0.019) in the ViV-TAVR group. Patients in the ViV-TAVR group had higher post-TAVR mean gradient (16 vs. 9 mm Hg; p < 0.001), but less moderate or severe aortic regurgitation (3.5% vs. 6.6%; p < 0.001). Post-TAVR gradients were highest in small SAVRs and stenotic SAVRs. Conclusions: Comparison with the benchmark NV-TAVR shows ViV-TAVR to be a safe and effective procedure in patients with failed SAVR who are at high risk for repeat surgery.

Original languageEnglish (US)
Pages (from-to)370-382
Number of pages13
JournalJournal of the American College of Cardiology
Volume72
Issue number4
DOIs
StatePublished - Jul 24 2018

Fingerprint

Bioprosthesis
Registries
Benchmarking
Mortality
Confidence Intervals
Transcatheter Aortic Valve Replacement
Aortic Valve
Reoperation
Surgical Instruments
Hospitalization
Heart Failure
Safety
Dental Porcelain
Aortic Valve Insufficiency
Medicare

Keywords

  • aortic stenosis
  • bioprosthetic valve failure
  • TAVI
  • TAVR
  • valve-in-valve TAVR

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Transcatheter Aortic Valve Replacement of Failed Surgically Implanted Bioprostheses : The STS/ACC Registry. / Tuzcu, E. Murat; Kapadia, Samir R.; Vemulapalli, Sreekanth; Carroll, John D.; Holmes, David; Mack, Michael J.; Thourani, Vinod H.; Grover, Frederick L.; Brennan, J. Matthew; Suri, Rakesh M.; Dai, David; Svensson, Lars G.

In: Journal of the American College of Cardiology, Vol. 72, No. 4, 24.07.2018, p. 370-382.

Research output: Contribution to journalArticle

Tuzcu, EM, Kapadia, SR, Vemulapalli, S, Carroll, JD, Holmes, D, Mack, MJ, Thourani, VH, Grover, FL, Brennan, JM, Suri, RM, Dai, D & Svensson, LG 2018, 'Transcatheter Aortic Valve Replacement of Failed Surgically Implanted Bioprostheses: The STS/ACC Registry', Journal of the American College of Cardiology, vol. 72, no. 4, pp. 370-382. https://doi.org/10.1016/j.jacc.2018.04.074
Tuzcu, E. Murat ; Kapadia, Samir R. ; Vemulapalli, Sreekanth ; Carroll, John D. ; Holmes, David ; Mack, Michael J. ; Thourani, Vinod H. ; Grover, Frederick L. ; Brennan, J. Matthew ; Suri, Rakesh M. ; Dai, David ; Svensson, Lars G. / Transcatheter Aortic Valve Replacement of Failed Surgically Implanted Bioprostheses : The STS/ACC Registry. In: Journal of the American College of Cardiology. 2018 ; Vol. 72, No. 4. pp. 370-382.
@article{29b1bf5c21724270937ac41812fd0530,
title = "Transcatheter Aortic Valve Replacement of Failed Surgically Implanted Bioprostheses: The STS/ACC Registry",
abstract = "Background: Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has been shown to be feasible, yet the safety and efficacy in relation to native valve (NV) TAVR are not known. Objectives: This study sought to evaluate the safety and effectiveness of ViV TAVR for failed surgical aortic valve replacement (SAVR) by comparing it with the benchmark of NV TAVR. Methods: Patients who underwent ViV-TAVR (n = 1,150) were matched 1:2 (on sex, high or extreme risk, hostile chest or porcelain aorta, 5-m-walk time, and Society of Thoracic Surgeons Predicted Risk of Mortality for reoperation) to patients undergoing NV-TAVR (n = 2,259). Baseline characteristics, procedural data, and in-hospital outcomes were obtained from the Transcatheter Valve Therapy Registry. The 30-day and 1-year outcomes were obtained from linked Medicare administrative claims data. Results: Unadjusted analysis revealed lower 30-day mortality (2.9{\%} vs. 4.8{\%}; p < 0.001), stroke (1.7{\%} vs. 3.0{\%}; p = 0.003), and heart failure hospitalizations (2.4{\%} vs. 4.6{\%}; p < 0.001) in the ViV-TAVR compared with NV-TAVR group. Adjusted analysis revealed lower 30-day mortality (hazard ratio: 0.503; 95{\%} confidence interval: 0.302 to 0.839; p = 0.008), lower 1-year mortality (hazard ratio: 0.653; 95{\%} confidence interval: 0.505 to 0.844; p = 0.001), and hospitalization for heart failure (hazard ratio: 0.685; 95{\%} confidence interval: 0.500 to 0.939; p = 0.019) in the ViV-TAVR group. Patients in the ViV-TAVR group had higher post-TAVR mean gradient (16 vs. 9 mm Hg; p < 0.001), but less moderate or severe aortic regurgitation (3.5{\%} vs. 6.6{\%}; p < 0.001). Post-TAVR gradients were highest in small SAVRs and stenotic SAVRs. Conclusions: Comparison with the benchmark NV-TAVR shows ViV-TAVR to be a safe and effective procedure in patients with failed SAVR who are at high risk for repeat surgery.",
keywords = "aortic stenosis, bioprosthetic valve failure, TAVI, TAVR, valve-in-valve TAVR",
author = "Tuzcu, {E. Murat} and Kapadia, {Samir R.} and Sreekanth Vemulapalli and Carroll, {John D.} and David Holmes and Mack, {Michael J.} and Thourani, {Vinod H.} and Grover, {Frederick L.} and Brennan, {J. Matthew} and Suri, {Rakesh M.} and David Dai and Svensson, {Lars G.}",
year = "2018",
month = "7",
day = "24",
doi = "10.1016/j.jacc.2018.04.074",
language = "English (US)",
volume = "72",
pages = "370--382",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "4",

}

TY - JOUR

T1 - Transcatheter Aortic Valve Replacement of Failed Surgically Implanted Bioprostheses

T2 - The STS/ACC Registry

AU - Tuzcu, E. Murat

AU - Kapadia, Samir R.

AU - Vemulapalli, Sreekanth

AU - Carroll, John D.

AU - Holmes, David

AU - Mack, Michael J.

AU - Thourani, Vinod H.

AU - Grover, Frederick L.

AU - Brennan, J. Matthew

AU - Suri, Rakesh M.

AU - Dai, David

AU - Svensson, Lars G.

PY - 2018/7/24

Y1 - 2018/7/24

N2 - Background: Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has been shown to be feasible, yet the safety and efficacy in relation to native valve (NV) TAVR are not known. Objectives: This study sought to evaluate the safety and effectiveness of ViV TAVR for failed surgical aortic valve replacement (SAVR) by comparing it with the benchmark of NV TAVR. Methods: Patients who underwent ViV-TAVR (n = 1,150) were matched 1:2 (on sex, high or extreme risk, hostile chest or porcelain aorta, 5-m-walk time, and Society of Thoracic Surgeons Predicted Risk of Mortality for reoperation) to patients undergoing NV-TAVR (n = 2,259). Baseline characteristics, procedural data, and in-hospital outcomes were obtained from the Transcatheter Valve Therapy Registry. The 30-day and 1-year outcomes were obtained from linked Medicare administrative claims data. Results: Unadjusted analysis revealed lower 30-day mortality (2.9% vs. 4.8%; p < 0.001), stroke (1.7% vs. 3.0%; p = 0.003), and heart failure hospitalizations (2.4% vs. 4.6%; p < 0.001) in the ViV-TAVR compared with NV-TAVR group. Adjusted analysis revealed lower 30-day mortality (hazard ratio: 0.503; 95% confidence interval: 0.302 to 0.839; p = 0.008), lower 1-year mortality (hazard ratio: 0.653; 95% confidence interval: 0.505 to 0.844; p = 0.001), and hospitalization for heart failure (hazard ratio: 0.685; 95% confidence interval: 0.500 to 0.939; p = 0.019) in the ViV-TAVR group. Patients in the ViV-TAVR group had higher post-TAVR mean gradient (16 vs. 9 mm Hg; p < 0.001), but less moderate or severe aortic regurgitation (3.5% vs. 6.6%; p < 0.001). Post-TAVR gradients were highest in small SAVRs and stenotic SAVRs. Conclusions: Comparison with the benchmark NV-TAVR shows ViV-TAVR to be a safe and effective procedure in patients with failed SAVR who are at high risk for repeat surgery.

AB - Background: Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has been shown to be feasible, yet the safety and efficacy in relation to native valve (NV) TAVR are not known. Objectives: This study sought to evaluate the safety and effectiveness of ViV TAVR for failed surgical aortic valve replacement (SAVR) by comparing it with the benchmark of NV TAVR. Methods: Patients who underwent ViV-TAVR (n = 1,150) were matched 1:2 (on sex, high or extreme risk, hostile chest or porcelain aorta, 5-m-walk time, and Society of Thoracic Surgeons Predicted Risk of Mortality for reoperation) to patients undergoing NV-TAVR (n = 2,259). Baseline characteristics, procedural data, and in-hospital outcomes were obtained from the Transcatheter Valve Therapy Registry. The 30-day and 1-year outcomes were obtained from linked Medicare administrative claims data. Results: Unadjusted analysis revealed lower 30-day mortality (2.9% vs. 4.8%; p < 0.001), stroke (1.7% vs. 3.0%; p = 0.003), and heart failure hospitalizations (2.4% vs. 4.6%; p < 0.001) in the ViV-TAVR compared with NV-TAVR group. Adjusted analysis revealed lower 30-day mortality (hazard ratio: 0.503; 95% confidence interval: 0.302 to 0.839; p = 0.008), lower 1-year mortality (hazard ratio: 0.653; 95% confidence interval: 0.505 to 0.844; p = 0.001), and hospitalization for heart failure (hazard ratio: 0.685; 95% confidence interval: 0.500 to 0.939; p = 0.019) in the ViV-TAVR group. Patients in the ViV-TAVR group had higher post-TAVR mean gradient (16 vs. 9 mm Hg; p < 0.001), but less moderate or severe aortic regurgitation (3.5% vs. 6.6%; p < 0.001). Post-TAVR gradients were highest in small SAVRs and stenotic SAVRs. Conclusions: Comparison with the benchmark NV-TAVR shows ViV-TAVR to be a safe and effective procedure in patients with failed SAVR who are at high risk for repeat surgery.

KW - aortic stenosis

KW - bioprosthetic valve failure

KW - TAVI

KW - TAVR

KW - valve-in-valve TAVR

UR - http://www.scopus.com/inward/record.url?scp=85049724049&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85049724049&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2018.04.074

DO - 10.1016/j.jacc.2018.04.074

M3 - Article

C2 - 30025572

AN - SCOPUS:85049724049

VL - 72

SP - 370

EP - 382

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 4

ER -