Clinical impact of pathology-proven etiology of severely stenotic aortic valves on mid-term outcomes in patients undergoing surgical aortic valve replacement

Abstract Aims We sought to perform a head-to-head comparison of contemporary 30-day outcomes and readmissions between valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) patients and a matched cohort of high-risk reoperative surgical aortic valve replacement (re-SAVR) patients using a large, multicentre, national database. Methods and results We utilized the nationally weighted 2012–16 National Readmission Database claims to identify all US adult patients with degenerated bioprosthetic aortic valves who underwent either VIV-TAVR (n = 3443) or isolated re-SAVR (n = 3372). Thirty-day outcomes were compared using multivariate analysis and propensity score matching (1:1). Unadjusted, VIV-TAVR patients had significantly lower 30-day mortality (2.7% vs. 5.0%), 30-day morbidity (66.4% vs. 79%), and rates of major bleeding (35.8% vs. 50%). On multivariable analysis, re-SAVR was a significant risk factor for both 30-day mortality [adjusted odds ratio (aOR) of VIV-SAVR (vs. re-SAVR) 0.48, 95% confidence interval (CI) 0.28–0.81] and 30-day morbidity [aOR for VIV-TAVR (vs. re-SAVR) 0.54, 95% CI 0.43–0.68]. After matching (n = 2181 matched pairs), VIV-TAVR was associated with lower odds of 30-day mortality (OR 0.41, 95% CI 0.23–0.74), 30-day morbidity (OR 0.53, 95% CI 0.43–0.72), and major bleeding (OR 0.66, 95% CI 0.51–0.85). Valve-in-valve TAVR was also associated with shorter length of stay (median savings of 2 days, 95% CI 1.3–2.7) and higher odds of routine home discharges (OR 2.11, 95% CI 1.61–2.78) compared to re-SAVR. Conclusion In this large, nationwide study of matched high-risk patients with degenerated bioprosthetic aortic valves, VIV-TAVR appears to confer an advantage over re-SAVR in terms of 30-day mortality, morbidity, and bleeding complications. Further studies are warranted to benchmark in low- and intermediate-risk patients and to adequately assess longer-term efficacy.

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Do rapid deployment aortic valves improve outcomes compared with surgical aortic valve replacement?: Table 1:

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivw226 ◽

2016 ◽

Vol 23 (5) ◽

pp. 814-820 ◽

Cited By ~ 8

Author(s):

Reece A. Davies ◽

Thilina D. Bandara ◽

Nisal K. Perera ◽

Yishay Orr

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Surgical Aortic Valve Replacement ◽

Aortic Valves ◽

Rapid Deployment

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Up to 7-Year Follow-up of Bicuspid Aortic Valves (BAV) Undergoing TAVI versus Surgical Aortic Valve Replacement (SAVR)

10.1055/s-0039-1678997 ◽

2019 ◽

Author(s):

T. Josic ◽

J. Koehne ◽

C. Liebetrau ◽

M. Schönburg ◽

K. Kim ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Surgical Aortic Valve Replacement ◽

Aortic Valves ◽

Bicuspid Aortic Valves

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Abstract 14140: The Weight of the Evidence: Comparison of Operatively Excised Aortic Valve Weights in Patients With High Gradient versus Low Gradient Aortic Stenosis and Overall Survival Following Aortic Valve Replacement

Circulation ◽

10.1161/circ.132.suppl_3.14140 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Sara M Negrotto ◽

Jeremy J Thaden ◽

Rakesh M Suri ◽

Joseph J Maleszewski ◽

Sorin V Pislaru ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Peripheral Resistance ◽

Stroke Volume Index ◽

Patient Characteristics ◽

Volume Index ◽

Surgical Aortic Valve Replacement ◽

Aortic Valves ◽

High Gradient

Introduction: Excised aortic valve weight (AVW) correlates with severity of AS. There is some debate about the true severity of AS in low gradient AS (LGAS) compared to high gradient AS (HGAS). We sought to compare patient characteristics and operatively excised AVW in patients with LGAS vs HGAS vs moderate AS. Methods: 916 patients with EF ≥50% undergoing surgical aortic valve replacement for AS between 2010-2012 were included. Clinical and echocardiographic characteristics of LGAS patients (AVA≤1cm 2 , MnG<40mmHg; N=68) were compared to HGAS patients (AVA≤1cm 2 , MnG≥40mmHg; N=745) and operatively excised AVW were compared to moderate AS (AVA>1cm 2 , MnG<40mmHg; N=102). Results: Compared to HGAS, LGAS patients were older (mean age 77 ± 10 vs 73 ± 10 years; p=0.001), often female (56% vs 38%; p=0.006), but without differences in diabetes (26% vs 29%; p=0.78), hyperlipidemia (85% vs 86%, p=0.86), coronary artery disease (49% vs 44%; p=0.53), or hypertension (81% vs 76%; p=0.38). LGAS patients predominantly had trileaflet aortic valves (91% vs 71%; p<0.001), smaller LVOT diameter (2.16 ± 0.15 vs 2.25 ± 0.20 cm; p=0.002), lower stroke volume index (42.1 ± 7.3 vs 49.0 ± 8.8 cc/m 2 ; p<0.001), lower systemic compliance (0.77 ± 0.30 vs 0.93 ± 0.33 ; p<0.001), but no difference in valvulo-arterial impedance (3.96 ± 0.76 vs. 3.84 ± 0.80, p=0.24) compared to HGAS. Excised AVW were lower in patients with LGAS vs HGAS (1.77 ± 0.76 vs 2.69 ± 1.26 g, p<0.001), but not different from moderate AS (1.77 ± 0.76 vs 2.04 ± 0.94 g; p=0.1). This relationship held true when AVW was indexed to body surface area. Three-year mortality post-valve replacement was significantly higher in LGAS compared to HGAS (22% vs 11%, p=0.02). Conclusions: LGAS occurs mostly in older female patients with trileaflet aortic valves. Excised AVW in LGAS is similar to moderate AS but lower than HGAS. However, systemic compliance is higher in LGAS vs HGAS contributing to increased afterload. Poorer outcomes after surgery in LGAS patients may be attributed to noncompliant vasculature which is not corrected with valve replacement and evaluation of patients with LGAS should include assessment of peripheral resistance.

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