Author + information
- Received July 31, 2019
- Revision received October 7, 2019
- Accepted October 15, 2019
- Published online March 16, 2020.
- Derrick Y. Tam, MDa,b,
- Christoffer Dharma, MScc,
- Rodolfo V. Rocha, MDd,
- Maral Ouzounian, MD, PhDd,
- Harindra C. Wijeysundera, MD, PhDb,c,e,
- Peter C. Austin, PhDb,c,
- Joanna Chikwe, MDf,g,
- Mario Gaudino, MDh and
- Stephen E. Fremes, MD, MSca,b,∗ ()
- aDivision of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- bInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- cInstitute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- dDivision of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- eDivision of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- fDepartment of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
- gState University of New York, Stony Brook, New York
- hDepartment of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York
- ↵∗Address for correspondence:
Dr. Stephen E. Fremes, Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room H4 05, Toronto, Ontario M4N 3M5, Canada.
Objectives The aim of this study was to compare early and late outcomes between redo surgical aortic valve replacement (AVR) and valve-in-valve (ViV) transcatheter AVR.
Background Published studies to date comparing redo surgical AVR (RS) with ViV transcatheter AVR for failed biological prostheses have been small and limited to early outcomes.
Methods Clinical and administrative databases for Ontario, Canada’s most populous province, were linked to obtain patients undergoing ViV and RS for failed previous biological prostheses. Propensity score matching was performed to account for differences in baseline characteristics. Early outcomes were compared using the McNemar test. Late mortality was compared between the matched groups using a Cox proportional hazards model.
Results A total of 558 patients undergoing intervention for failed biological prostheses between March 31, 2008, and September 30, 2017, at 11 Ontario institutions (ViV, n = 214; RS, n = 344) were included. Patients who underwent ViV were older and had more comorbidities. Propensity matching on 27 variables yielded similar groups for comparison (n = 131 pairs). Mean time from initial AVR to RS or ViV was 8.6 ± 4.4 years and 11.3 ± 4.5 years, respectively. Thirty-day mortality was significantly lower with ViV compared with RS (absolute risk difference: −7.5%; 95% confidence interval: −12.6% to −2.3%). The rates of permanent pacemaker implantation and blood transfusions were also lower with ViV, as was length of stay. Survival at 5 years was higher with ViV (76.8% vs. 66.8%; hazard ratio: 0.55; 95% confidence interval: 0.30 to 0.99; p = 0.04).
Conclusions ViV TAVR was associated with lower early mortality, morbidity, and length of hospital stay and with increased survival compared with RS and may be the preferred approach for the treatment of failed biological prostheses.
- aortic valve
- prosthesis failure
- redo surgical aortic valve replacement
- transcatheter aortic valve replacement
This study was supported by the ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. Parts of this material are based on data and information compiled and provided by the Ontario Ministry of Health and Long-Term Care, the Canadian Institute for Health Information, and CorHealth Ontario. The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. Funding for this project was obtained from the Bernard S. Goldman Chair in Cardiovascular Surgery. This work was completed as part of a PhD thesis requirement (Dr. Tam). Dr. Tam is supported by a Canadian Institutes of Health Research fellowship. Dr. Rocha is supported by the Black Family Foundation Fellowship Award. Dr. Wijeysundera is supported by a Phase 2 Clinician Scientist Award from the Heart and Stroke Foundation of Canada, Ontario Office; and has received research funding support from Medtronic and Edwards Lifesciences. Dr. Austin is supported by a Mid-Career Investigator Award from the Heart and Stroke Foundation. Dr. Fremes is supported by the Bernard S. Goldman Chair in Cardiovascular Surgery. Dr. Chikwe has received speaking honoraria from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 31, 2019.
- Revision received October 7, 2019.
- Accepted October 15, 2019.
- 2020 American College of Cardiology Foundation
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