PMD113 - COST–UTILITY OF SURGICAL SUTURELESS BIOPROSTHESES VS. TAVI IN AORTIC VALVE REPLACEMENT FOR PATIENTS AT INTERMEDIATE AND HIGH SURGICAL RISK

Objectives: Transcatheter aortic valve-in-valve implantation (ViV) is an innovative treatment for failed tissue valves (TV) in patients at high surgical risk. However, direct comparative data with standard repeat surgical aortic valve replacement (RE-SAVR) is scarce. We aimed to compare outcomes after ViV to conventional RE-SAVR in two European centers with established interventional programs. Methods: Retrospectively we explored in-hospital databases for patients ≥60 years, treated for degenerated TV. Patients with endocarditis and combined procedures were excluded. Primary endpoints were adjudicated according to VARC-2 criteria. Results: Between 2002 and 2015, 130 patients were treated for isolated failure of aortic TV’s (ViV: n=71, RE-SAVR: n=59). In ViV, Edwards Sapien valve (ESV) was most frequently used (n=36) but implanted into larger TV’s (CoreValve TV size: 22.2±1.3mm vs. ESV TV size: 24.1±2.0mm, p<0.01). Both age and logistic EuroSCORE I were higher in ViV compared to RE-SAVR (78.6±7.5 vs. 72.9±6.5 ys, p<0.01; 25.1±18.9 vs. 16.8±9.4%, p<0.01). Thirty-day mortality was not significantly different with 4.2% (3/71) after ViV vs. 5.1% (3/59) post RE-SAVR (p=1.0). Device success was achieved in 54.9% (n=39) in ViV and all RE-SAVR patients (p<0.01). Perioperative stroke was not observed after ViV and in 2 patients after RE-SAVR (3.4%, p=0.2). Intensive-care stay was longer after RE-SAVR (3.4±2.9d vs. 1.9±1.8d, p<0.01). Following ViV, 22.5% (n=16) of patients had mild aortic regurgitation, vs. 11.3% (n=8; p=0.25) after RE-SAVR. Mean transvalvular pressure gradients at discharge were higher post ViV (19.3±7.3 vs.12.2±5.6mmHg, p<0.01). Rate of permanent pacemaker implantation was lower after ViV (9.9% vs. 27.1%, p<0.01). Survival at 90- and 180-days was 93.8% and 91.8% vs. 94.4% and 94.4% after ViV and RE-SAVR respectively (p=0.87). Conclusion: Despite a higher risk profile, early mortality was not different between the two treatment arms. Although ViV resulted in elevated postoperative transvalvular pressure gradients and therefore a lower rate of device success, mortality after 180-days was similar to RE-SAVR. At present, both techniques serve as complementary approaches and allow individualized patient care.

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TCT-104 Feasibility Study of the Repositionable Lotus Aortic Valve Replacement System: 3-Month Outcomes in 11 Patients at High Surgical Risk (REPRISE I)

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2012.08.120 ◽

2012 ◽

Vol 60 (17) ◽

pp. B32-B33 ◽

Cited By ~ 1

Author(s):

Ian Meredith ◽

Stephen Worthley ◽

Robert Whitbourn ◽

Paul Antonis ◽

Joseph Montarello ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Feasibility Study ◽

Surgical Risk ◽

High Surgical Risk ◽

Replacement System

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CRT-800.33 Surgical versus Transcatheter Aortic Valve Replacement in Non-High Surgical Risk Severe Aortic Stenosis: A Systematic Review

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2016.12.240 ◽

2017 ◽

Vol 10 (3) ◽

pp. S73

Author(s):

Tariq Enezate ◽

Arun Kumar ◽

Mazen Abu Fadel ◽

Mitul Patel ◽

Ashraf Al-Dadah ◽

...

Keyword(s):

Systematic Review ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Severe Aortic Stenosis ◽

Surgical Risk ◽

Transcatheter Aortic Valve ◽

High Surgical Risk

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Transapical Implantation of a 2nd-Generation JenaValve Device in Patient with Extremely High Surgical Risk

Case Reports in Cardiology ◽

10.1155/2015/458151 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6

Author(s):

Juan Mieres ◽

Marcelo Menéndez ◽

Carlos Fernández-Pereira ◽

Miguel Rubio ◽

Alfredo E. Rodríguez

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Second Generation ◽

Coronary Intervention ◽

Implantation Technique ◽

Femoral Access ◽

Surgical Risk ◽

Transcatheter Aortic Valve ◽

High Surgical Risk

Transcatheter Aortic Valve Replacement (TAVR) is performed in patients who are poor surgical candidates. Many patients have inadequate femoral access, and alternative access sites have been used such as the transapical approach discussed in this paper. We present an elderly and fragile patient not suitable for surgery for unacceptable high risk, including poor ventricular function, previous myocardial infarction with percutaneous coronary intervention, pericardial effusion, and previous cardiac surgery with replacement of mechanical mitral valve. Transapical aortic valve replacement with a second-generation self-expanding JenaValve is performed. The JenaValve is a second-generation transapical TAVR valve consisting of a porcine root valve mounted on a low-profile nitinol stent. The valve is fully retrievable and repositionable. We discuss transapical access, implantation technique, and feasibility of valve implantation in this extremely high surgical risk patient.

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Ten Years’ Experience of Transcatheter Aortic Valve Replacement at the Faculty of Medicine Siriraj Hospital: Transapical vs. Transfemoral Approach

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.05.12353 ◽

2021 ◽

Vol 104 (5) ◽

pp. 846-852

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Clinical Outcomes ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Severe Aortic Stenosis ◽

Surgical Risk ◽

Transcatheter Aortic Valve ◽

All Cause Mortality ◽

High Surgical Risk

Objective: To compare 30 days mortality and clinical outcomes between transapical transcatheter aortic valve replacement (TA-TAVR) and transfemoral transcatheter aortic valve replacement (TF-TAVR) in Thai patients who underwent transcatheter aortic valve replacement (TAVR). Materials and Methods: The observational study included 83 consecutive patients that attended the authors’ center for TAVR between January 2009 and December 2019. The patients’ baseline demographic data and surgical risks were recorded. The clinical outcomes at 30 days and one year were prespecified targets. Results: Eighty-three patients underwent TAVR at the authors’ center between 2009 and 2019, with 77% of them considered inoperable or at high surgical risk by the authors’ heart team. Of the 83 patients, 40 had a porcelain aorta (48.2%). The median Society of Thoracic Surgeons (STS) score and logistic EuroSCORE were 5.7 (4.6, 8.3) and 21.7 (15.2, 31.2), respectively. Twenty-two patients had a transapical approach (26.5%). The cardiovascular (CV) mortality rate was 2.4% at 30 days. The all-cause mortality 30-day rate and 1-year rate were 3.6% and 12.0%, respectively. Comparing between TA-TAVR and TF-TAVR, TA-TAVR had a significantly lower incidence of new permanent pacemaker placement after TAVR (p=0.032), but a longer length of hospital stay (p=0.087). There was a trend for a higher incidence of new onset atrial fibrillation in TA-TAVR. The all-cause mortality 30-day rate and 1-year rate were similar between TA-TAVR and TF-TAVR. Conclusion: In Thai symptomatic severe aortic stenosis patients, of whom most patients were considered inoperable or at high surgical risk, both TA-TAVR and TF-TAVR showed acceptable short- and long-term clinical outcomes. Keywords: Severe aortic stenosis (severe AS), Transcatheter aortic valve replacement (TAVR), Transfemoral (TF), Transapical (TA)

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