Failure of Surgical Aortic Valve Prostheses: An Analysis of Heart Team Decisions and Postoperative Outcomes

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 Aug 10

PMID 39124728

Authors

Philipp Schnackenburg

Shekhar Saha

Ahmad Ali

Konstanze Maria Horke

Joscha Buech

Christoph S Mueller

Sebastian Sadoni

Martin Orban

Rainer Kaiser

Philipp Maximilian Doldi

Konstantinos Rizas

Steffen Massberg

Christian Hagl

Dominik Joskowiak

Affiliations

Soon will be listed here.

Abstract

To analyze Heart Team decisions and outcomes following failure of surgical aortic valve replacement (SAVR) prostheses. Patients undergoing re-operations following index SAVR (Redo-SAVR) and those undergoing valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) following SAVR were included in this study. Patients who underwent index SAVR and/or Redo-SAVR for endocarditis were excluded. Data are presented as medians and 25th-75th percentiles, or absolute numbers and percentages. Outcomes were analyzed in accordance to the VARC-3 criteria. Between 01/2015 and 03/2021, 53 patients underwent Redo-SAVR, 103 patients ViV-TAVR. Mean EuroSCORE II was 5.7% (3.5-8.5) in the Redo-SAVR group and 9.2% (5.4-13.6) in the ViV group. In the Redo-SAVR group, 12 patients received aortic root enlargement (22.6%). Length of hospital and ICU stay was longer in the Redo-SAVR group ( < 0.001; < 0.001), PGmax and PGmean were lower in the Redo-SAVR group as compared to the ViV-TAVR group (18 mmHg (10-30) vs. 26 mmHg (19-38), < 0.001) (9 mmHg (6-15) vs. 15 mmHg (9-21), < 0.001). A higher rate of paravalvular leakage was seen in the ViV-TAVR group ( = 0.013). VARC-3 Early Safety were comparable between the two populations ( = 0.343). Survival at 1 year and 5 years was 82% and 36% in the ViV-TAVR cohort and 84% and 77% in the Redo-SAVR cohort. The variables were patient age (OR 1.061; [95% CI 1.020-1.104], = 0.004), coronary heart disease (OR 2.648; [95% CI 1.160-6.048], = 0.021), and chronic renal insufficiency (OR 2.711; [95% CI 1.160-6.048], = 0.021) showed a significant correlation to ViV-TAVR. Heart Team decisions are crucial in the treatment of patients with degenerated aortic bioprostheses and lead to a low mortality in both treatment paths thanks to patient-specific therapy planning. ViV-TAVR offers a treatment for elderly or intermediate-risk profile patients with comparable short-term mortality. However, this therapy is associated with increased pressure gradients and a high prevalence of paravalvular leakage. Redo-SAVR enables the surgical treatment of concomitant cardiac pathologies and allows anticipation for later VIV-TAVR by implanting the largest possible valve prostheses.

Citing Articles

Optimizing Aortic Valve Reoperations: Ministernotomy vs. Full Sternotomy.

Mikus E, Fiorentino M, Sangiorgi D, Calvi S, Tenti E, Tripodi A J Clin Med. 2025; 14(4).

PMID: 40004743 PMC: 11856763. DOI: 10.3390/jcm14041213.

References

Saha S, Varghese S, Ahmad A, Jebran A, Waezi N, Niehaus H . Complex Valve Surgery in Elderly Patients: Increasingly Necessary and Surprisingly Feasible. Thorac Cardiovasc Surg. 2018; 68(2):107-113. DOI: 10.1055/s-0038-1670663. View

Mack M, Leon M, Thourani V, Makkar R, Kodali S, Russo M . Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. N Engl J Med. 2019; 380(18):1695-1705. DOI: 10.1056/NEJMoa1814052. View

Dvir D, Webb J, Bleiziffer S, Pasic M, Waksman R, Kodali S . Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. JAMA. 2014; 312(2):162-70. DOI: 10.1001/jama.2014.7246. View

Kherallah R, Koneru S, Krajcer Z, Preventza O, Dougherty K, McCormack M . Hemodynamic outcomes after valve-in-valve transcatheter aortic valve replacement: a single-center experience. Ann Cardiothorac Surg. 2021; 10(5):630-640. PMC: 8505917. DOI: 10.21037/acs-2021-tviv-131. View

Patel P, Chiou E, Cao Y, Binongo J, Guyton R, Leshnower B . Isolated Redo Aortic Valve Replacement Versus Valve-in-Valve Transcatheter Valve Replacement. Ann Thorac Surg. 2020; 112(2):539-545. DOI: 10.1016/j.athoracsur.2020.08.048. View

Russo G, Tang G, Sangiorgi G, Pedicino D, Enriquez-Sarano M, Maisano F . Lifetime Management of Aortic Stenosis: Transcatheter Versus Surgical Treatment for Young and Low-Risk Patients. Circ Cardiovasc Interv. 2022; 15(11):915-927. DOI: 10.1161/CIRCINTERVENTIONS.122.012388. View

Tam D, Rocha R, Wijeysundera H, Austin P, Dvir D, Fremes S . Surgical valve selection in the era of transcatheter aortic valve replacement in the Society of Thoracic Surgeons Database. J Thorac Cardiovasc Surg. 2019; 159(2):416-427.e8. DOI: 10.1016/j.jtcvs.2019.05.081. View

Neupane S, Singh H, Lammer J, Othman H, Yamasaki H, Rosman H . Meta-Analysis of Transcatheter Valve-in-Valve Implantation Versus Redo Aortic Valve Surgery for Bioprosthetic Aortic Valve Dysfunction. Am J Cardiol. 2018; 121(12):1593-1600. DOI: 10.1016/j.amjcard.2018.02.054. View

Deharo P, Bisson A, Herbert J, Lacour T, Saint Etienne C, Jaussaud N . Valve-in-valve transcatheter aortic valve implantation after failed surgically implanted aortic bioprosthesis versus native transcatheter aortic valve implantation for aortic stenosis: Data from a nationwide analysis. Arch Cardiovasc Dis. 2020; 114(1):41-50. DOI: 10.1016/j.acvd.2020.04.005. View

10.

Dahlbacka S, Laakso T, Kinnunen E, Moriyama N, Laine M, Virtanen M . Patient-Prosthesis Mismatch Worsens Long-Term Survival: Insights From the FinnValve Registry. Ann Thorac Surg. 2020; 111(4):1284-1290. DOI: 10.1016/j.athoracsur.2020.06.026. View

11.

Herrmann H, Daneshvar S, Fonarow G, Stebbins A, Vemulapalli S, Desai N . Prosthesis-Patient Mismatch in Patients Undergoing Transcatheter Aortic Valve Replacement: From the STS/ACC TVT Registry. J Am Coll Cardiol. 2018; 72(22):2701-2711. DOI: 10.1016/j.jacc.2018.09.001. View

12.

Salaun E, Clavel M, Rodes-Cabau J, Pibarot P . Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation. Heart. 2018; 104(16):1323-1332. DOI: 10.1136/heartjnl-2017-311582. View

13.

Malik A, Yandrapalli S, Zaid S, Shetty S, Aronow W, Ahmad H . Valve-in-Valve Transcatheter Implantation Versus Redo Surgical Aortic Valve Replacement. Am J Cardiol. 2020; 125(9):1378-1384. DOI: 10.1016/j.amjcard.2020.02.005. View

14.

Peterss S, Fortmann C, Pichlmaier M, Bagaev E, Shrestha M, Hagl C . Advanced age: a contraindication for triple-valve surgery?. J Heart Valve Dis. 2012; 21(5):641-9. View

15.

Woitek F, Stachel G, Kiefer P, Haussig S, Leontyev S, Schlotter F . Treatment of failed aortic bioprostheses: An evaluation of conventional redo surgery and transfemoral transcatheter aortic valve-in-valve implantation. Int J Cardiol. 2019; 300:80-86. DOI: 10.1016/j.ijcard.2019.09.039. View

16.

Genereux P, Piazza N, Alu M, Nazif T, Hahn R, Pibarot P . Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research. Eur Heart J. 2021; 42(19):1825-1857. DOI: 10.1093/eurheartj/ehaa799. View

17.

Bernardi F, Dvir D, Rodes-Cabau J, B Ribeiro H . Valve-in-Valve Challenges: How to Avoid Coronary Obstruction. Front Cardiovasc Med. 2019; 6:120. PMC: 6716332. DOI: 10.3389/fcvm.2019.00120. View

18.

James Edelman J, Khan J, Rogers T, Shults C, Satler L, Ben-Dor I . Valve-in-Valve TAVR: State-of-the-Art Review. Innovations (Phila). 2019; 14(4):299-310. DOI: 10.1177/1556984519858020. View

19.

Nalluri N, Atti V, Munir A, Karam B, Patel N, Kumar V . Valve in valve transcatheter aortic valve implantation (ViV-TAVI) versus redo-Surgical aortic valve replacement (redo-SAVR): A systematic review and meta-analysis. J Interv Cardiol. 2018; 31(5):661-671. DOI: 10.1111/joic.12520. View

20.

Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J . 2021 ESC/EACTS Guidelines for the management of valvular heart disease. EuroIntervention. 2021; 17(14):e1126-e1196. PMC: 9725093. DOI: 10.4244/EIJ-E-21-00009. View