Meta-Analysis of Valve-in-Valve Transcatheter Aortic Valve Implantation Versus Redo-surgical Aortic Valve Replacement in Failed Bioprosthetic Aortic Valve

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This meta-analysis was conducted to compare clinical outcomes of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) versus redo-surgical aortic valve replacement (Redo-SAVR) in failed bioprosthetic aortic valves. We conducted a comprehensive review of previous publications of all relevant studies through August 2020. Twelve observational studies were included with a total of 8,430 patients, and a median-weighted follow-up period of 1.74 years. A pooled analysis of the data showed no significant difference in all-cause mortality (OR 1.15; 95% CI 0.93 to 1.43; p = 0.21), cardiovascular mortality, myocardial infarction, permanent pacemaker implantation, and the rate of moderate to severe paravalvular leakage between ViV-TAVI and Redo-SAVR groups. The rate of major bleeding (OR 0.36; 95% CI 0.16 to 0.83, p = 0.02), procedural mortality (OR 0.41; 95% CI 0.18 to 0.96, p = 0.04), 30-day mortality (OR 0.58; 95% CI 0.45 to 0.74, p <0.0001), and the rate of stroke (OR 0.65; 95% CI 0.52 to 0.81, p = 0.0001) were significantly lower in the ViV- TAVI arm when compared with Redo-SAVR arm. The mean transvalvular pressure gradient was significantly higher post-implantation in the ViV-TAVI group when compared with the Redo-SAVR arm (Mean difference 3.92; 95% CI 1.97 to 5.88, p < 0.0001). In conclusion, compared with Redo-SAVR, ViV-TAVI is associated with a similar risk of all-cause mortality, cardiovascular mortality, myocardial infarction, permanent pacemaker implantation, and the rate of moderate to severe paravalvular leakage. However, the rate of major bleeding, stroke, procedural mortality and 30-day mortality were significantly lower in the ViV-TAVI group when compared with Redo-SAVR.

Section snippets

Methods

We conducted a comprehensive review of previous publications of all relevant studies through August 2020. We searched PUBMED, EMBASE, and COCHRANE databases. We included studies that met our criteria of: (1) the study compared clinical outcomes between ViV- TAVI versus Redo-SAVR in patients with failed bioprosthetic aortic valve, (2) the study reported more than one clinical outcome. The meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and

Results

Twelve retrospective observational studies were included with a total of 8,430 patients (Figure 1).5,6,15,16,7, 8, 9, 10, 11, 12, 13, 14 The median-weighted follow up period was 1.74 years. Characteristics of included studies and patients are described in Tables 1 and 2. A pooled analysis of the data showed no significant difference in all-cause mortality between ViV-TAVI and Redo-SAVR groups (OR 1.15; 95% CI 0.93 to 1.43; p = 0.21, I2=0%) (Figure 2).Meanwhile, procedural mortality (OR 0.41;

Discussion

Over the past 2 decades, more bioprosthetic valves have been utilized in comparison to mechanical valves.17 Since bioprosthetic valves degenerate within 10 years and the general population is getting older, managing degenerating bioprosthetic valves is currently a common entity and it is expected to increase exponentially. TAVI for native aortic stenosis has been studied extensively and has been proven to be non-inferior to SAVR in patients with all surgical risks. However, the data that

Author Agreement Statement

We the undersigned declare that this manuscript is original, has not been published before and is not currently being considered for publication elsewhere.

We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us.

We understand that the Corresponding Author is the sole contact

Declaration of Interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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