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Transcatheter Replacement of Transcatheter Versus Surgically Implanted Aortic Valve Bioprostheses
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2021-01-01 , DOI: 10.1016/j.jacc.2020.10.053 Uri Landes 1 , Janarthanan Sathananthan 2 , Guy Witberg 3 , Ole De Backer 4 , Lars Sondergaard 4 , Mohamed Abdel-Wahab 5 , David Holzhey 5 , Won-Keun Kim 6 , Christian Hamm 6 , Nicola Buzzatti 7 , Matteo Montorfano 7 , Sebastian Ludwig 8 , Lenard Conradi 8 , Moritz Seiffert 8 , Mayra Guerrero 9 , Abdallah El Sabbagh 9 , Josep Rodés-Cabau 10 , Leonardo Guimaraes 10 , Pablo Codner 3 , Taishi Okuno 11 , Thomas Pilgrim 11 , Claudia Fiorina 12 , Antonio Colombo 13 , Antonio Mangieri 13 , Helene Eltchaninoff 14 , Luis Nombela-Franco 15 , Maarten P H Van Wiechen 16 , Nicolas M Van Mieghem 16 , Didier Tchétché 17 , Wolfgang H Schoels 18 , Matthias Kullmer 18 , Corrado Tamburino 19 , Jan-Malte Sinning 20 , Baravan Al-Kassou 20 , Gidon Y Perlman 21 , Haim Danenberg 21 , Alfonso Ielasi 22 , Chiara Fraccaro 23 , Giuseppe Tarantini 23 , Federico De Marco 24 , Simon R Redwood 25 , John C Lisko 26 , Vasilis C Babaliaros 26 , Mika Laine 27 , Roberto Nerla 28 , Fausto Castriota 28 , Ariel Finkelstein 29 , Itamar Loewenstein 29 , Amnon Eitan 30 , Ronen Jaffe 30 , Philipp Ruile 31 , Franz J Neumann 31 , Nicolo Piazza 32 , Hind Alosaimi 32 , Horst Sievert 33 , Kolja Sievert 33 , Marco Russo 34 , Martin Andreas 34 , Matjaz Bunc 35 , Azeem Latib 36 , Rebecca Godfrey 37 , David Hildick-Smith 37 , Ming-Yu A Chuang 2 , Philipp Blanke 2 , Jonathon Leipsic 2 , David A Wood 2 , Tamim M Nazif 38 , Susheel Kodali 38 , Marco Barbanti 19 , Ran Kornowski 3 , Martin B Leon 38 , John G Webb 2
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2021-01-01 , DOI: 10.1016/j.jacc.2020.10.053 Uri Landes 1 , Janarthanan Sathananthan 2 , Guy Witberg 3 , Ole De Backer 4 , Lars Sondergaard 4 , Mohamed Abdel-Wahab 5 , David Holzhey 5 , Won-Keun Kim 6 , Christian Hamm 6 , Nicola Buzzatti 7 , Matteo Montorfano 7 , Sebastian Ludwig 8 , Lenard Conradi 8 , Moritz Seiffert 8 , Mayra Guerrero 9 , Abdallah El Sabbagh 9 , Josep Rodés-Cabau 10 , Leonardo Guimaraes 10 , Pablo Codner 3 , Taishi Okuno 11 , Thomas Pilgrim 11 , Claudia Fiorina 12 , Antonio Colombo 13 , Antonio Mangieri 13 , Helene Eltchaninoff 14 , Luis Nombela-Franco 15 , Maarten P H Van Wiechen 16 , Nicolas M Van Mieghem 16 , Didier Tchétché 17 , Wolfgang H Schoels 18 , Matthias Kullmer 18 , Corrado Tamburino 19 , Jan-Malte Sinning 20 , Baravan Al-Kassou 20 , Gidon Y Perlman 21 , Haim Danenberg 21 , Alfonso Ielasi 22 , Chiara Fraccaro 23 , Giuseppe Tarantini 23 , Federico De Marco 24 , Simon R Redwood 25 , John C Lisko 26 , Vasilis C Babaliaros 26 , Mika Laine 27 , Roberto Nerla 28 , Fausto Castriota 28 , Ariel Finkelstein 29 , Itamar Loewenstein 29 , Amnon Eitan 30 , Ronen Jaffe 30 , Philipp Ruile 31 , Franz J Neumann 31 , Nicolo Piazza 32 , Hind Alosaimi 32 , Horst Sievert 33 , Kolja Sievert 33 , Marco Russo 34 , Martin Andreas 34 , Matjaz Bunc 35 , Azeem Latib 36 , Rebecca Godfrey 37 , David Hildick-Smith 37 , Ming-Yu A Chuang 2 , Philipp Blanke 2 , Jonathon Leipsic 2 , David A Wood 2 , Tamim M Nazif 38 , Susheel Kodali 38 , Marco Barbanti 19 , Ran Kornowski 3 , Martin B Leon 38 , John G Webb 2
Affiliation
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BACKGROUND
Surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR) are now both used to treat aortic stenosis in patients in whom life expectancy may exceed valve durability. The choice of initial bioprosthesis should therefore consider the relative safety and efficacy of potential subsequent interventions. OBJECTIVES
The aim of this study was to compare TAVR in failed transcatheter aortic valves (TAVs) versus surgical aortic valves (SAVs). METHODS
Data were collected on 434 TAV-in-TAV and 624 TAV-in-SAV consecutive procedures performed at centers participating in the Redo-TAVR international registry. Propensity score matching was applied, and 330 matched (165:165) patients were analyzed. Principal endpoints were procedural success, procedural safety, and mortality at 30 days and 1 year. RESULTS
For TAV-in-TAV versus TAV-in-SAV, procedural success was observed in 120 (72.7%) versus 103 (62.4%) patients (p = 0.045), driven by a numerically lower frequency of residual high valve gradient (p = 0.095), ectopic valve deployment (p = 0.081), coronary obstruction (p = 0.091), and conversion to open heart surgery (p = 0.082). Procedural safety was achieved in 116 (70.3%) versus 119 (72.1%) patients (p = 0.715). Mortality at 30 days was 5 (3%) after TAV-in-TAV and 7 (4.4%) after TAV-in-SAV (p = 0.570). At 1 year, mortality was 12 (11.9%) and 10 (10.2%), respectively (p = 0.633). Aortic valve area was larger (1.55 ± 0.5 cm2 vs. 1.37 ± 0.5 cm2; p = 0.040), and the mean residual gradient was lower (12.6 ± 5.2 mm Hg vs. 14.9 ± 5.2 mm Hg; p = 0.011) after TAV-in-TAV. The rate of moderate or greater residual aortic regurgitation was similar, but mild aortic regurgitation was more frequent after TAV-in-TAV (p = 0.003). CONCLUSIONS
In propensity score-matched cohorts of TAV-in-TAV versus TAV-in-SAV patients, TAV-in-TAV was associated with higher procedural success and similar procedural safety or mortality.
中文翻译：
经导管替代经导管与手术植入的主动脉瓣生物假体
背景手术主动脉瓣置换术和经导管主动脉瓣置换术（TAVR）现在都用于治疗预期寿命可能超过瓣膜耐久性的患者的主动脉瓣狭窄。因此，初始生物假体的选择应考虑潜在后续干预措施的相对安全性和有效性。目的 本研究的目的是比较失败的经导管主动脉瓣 (TAV) 与手术主动脉瓣 (SAV) 的 TAVR。方法 收集了在参与 Redo-TAVR 国际注册中心的 434 个 TAV-in-TAV 和 624 个 TAV-in-SAV 连续手术的数据。应用倾向评分匹配，并分析了 330 名匹配 (165:165) 的患者。主要终点是手术成功、手术安全和 30 天和 1 年的死亡率。结果 对于 TAV-in-TAV 与 TAV-in-SAV，在 120（72.7%）和 103（62.4%）名患者（p = 0.045）中观察到手术成功，这是由残余高瓣膜梯度（p = 0.095)、异位瓣膜部署 (p = 0.081)、冠状动脉阻塞 (p = 0.091) 和转换为心脏直视手术 (p = 0.082)。116 名 (70.3%) 和 119 名 (72.1%) 患者实现了手术安全性 (p = 0.715)。TAV-in-TAV 后 30 天的死亡率为 5 (3%)，TAV-in-SAV 后为 7 (4.4%)（p = 0.570）。1 年时，死亡率分别为 12 (11.9%) 和 10 (10.2%) (p = 0.633)。主动脉瓣面积较大（1.55 ± 0.5 cm2 vs. 1.37 ± 0.5 cm2；p = 0.040），TAV-后平均残余梯度较低（12.6 ± 5.2 mm Hg vs. 14.9 ± 5.2 mm Hg；p = 0.011）在 TAV。中度或更大的残余主动脉瓣返流率相似，但 TAV-in-TAV 后轻度主动脉瓣关闭不全更频繁（p = 0.003）。结论 在 TAV-in-TAV 与 TAV-in-SAV 患者的倾向评分匹配队列中，TAV-in-TAV 与更高的手术成功率和相似的手术安全性或死亡率相关。
更新日期：2021-01-01
中文翻译：
经导管替代经导管与手术植入的主动脉瓣生物假体
背景手术主动脉瓣置换术和经导管主动脉瓣置换术（TAVR）现在都用于治疗预期寿命可能超过瓣膜耐久性的患者的主动脉瓣狭窄。因此，初始生物假体的选择应考虑潜在后续干预措施的相对安全性和有效性。目的 本研究的目的是比较失败的经导管主动脉瓣 (TAV) 与手术主动脉瓣 (SAV) 的 TAVR。方法 收集了在参与 Redo-TAVR 国际注册中心的 434 个 TAV-in-TAV 和 624 个 TAV-in-SAV 连续手术的数据。应用倾向评分匹配，并分析了 330 名匹配 (165:165) 的患者。主要终点是手术成功、手术安全和 30 天和 1 年的死亡率。结果 对于 TAV-in-TAV 与 TAV-in-SAV，在 120（72.7%）和 103（62.4%）名患者（p = 0.045）中观察到手术成功，这是由残余高瓣膜梯度（p = 0.095)、异位瓣膜部署 (p = 0.081)、冠状动脉阻塞 (p = 0.091) 和转换为心脏直视手术 (p = 0.082)。116 名 (70.3%) 和 119 名 (72.1%) 患者实现了手术安全性 (p = 0.715)。TAV-in-TAV 后 30 天的死亡率为 5 (3%)，TAV-in-SAV 后为 7 (4.4%)（p = 0.570）。1 年时，死亡率分别为 12 (11.9%) 和 10 (10.2%) (p = 0.633)。主动脉瓣面积较大（1.55 ± 0.5 cm2 vs. 1.37 ± 0.5 cm2；p = 0.040），TAV-后平均残余梯度较低（12.6 ± 5.2 mm Hg vs. 14.9 ± 5.2 mm Hg；p = 0.011）在 TAV。中度或更大的残余主动脉瓣返流率相似，但 TAV-in-TAV 后轻度主动脉瓣关闭不全更频繁（p = 0.003）。结论 在 TAV-in-TAV 与 TAV-in-SAV 患者的倾向评分匹配队列中，TAV-in-TAV 与更高的手术成功率和相似的手术安全性或死亡率相关。
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