Abstract 14342: Redo Surgical Aortic Valve Replacement versus Valve in Valve Transcatheter Aortic Valve Replacement

Abstract

Introduction: There has been a recent trend towards the increased use of biologic valves at the time of surgical aortic valve replacement (SAVR) with an understanding there may be a potential need for future valve intervention. In this study, we compared the clinical outcomes of Redo-SAVR with valve-in-valve transcatheter aortic valve replacement (VIVTAVR) in patients with a prior history of SAVR. Methods: From 2012 to 2019, 263 patients underwent isolated aortic valve reintervention after prior SAVR: VIV-TAVR (n=187) or redo-SAVR (n=86). Multivariable analysis was performed to identify risk factors mortality and aortic reintervention. Sub-analyses were performed to compare VIV-TAVR patients to Redo-SAVR patients undergoing biologic valve explant and implant (Biologic) as well as VIV-TAVR and Redo-SAVR patients matched by STS Predicted Risk of Mortality (STS PROM). Results: Operative mortality for the Redo-SAVR and VIV-TAVR was 1.2% (1) and 1.6% (3) respectively (p=0.92). Redo-SAVR patients had an increased stroke rate (7.0% vs 1.1%, p=0.02) and longer postoperative length of stay (7 vs 2 days, p<0.0001). VIV-TAVR patients had a higher rate of ≥1+ paravalvular leak (PVL) (21.4% versus 3%, p=0.0002) and a lesser reduction in transvalvular gradient (-21.9 ± 17.6mmHg vs -30.3 ± 20.7mmHg, p=0.0038). The difference in PVL was maintained during the Biologic Sub-analysis (p=0.0034). In the STS PROM Sub-analysis, early mortality was the same for each group (1.2%), and the differences in PVL (p=0.0002) and in transvalvular gradient reduction (p=0.005) were maintained. Preoperative renal failure (p=0.006) and cerebrovascular disease (p=0.04) were risk factors for mortality and prior myocardial infarction (p=0.04) was a risk factor for aortic reoperation for VIV-TAVR. No risk factors were identified for Redo-SAVR. Conclusions: Aortic valve reintervention following prior SAVR is associated with outstanding clinical outcomes. Both Redo-SAVR and VIV-TAVR can be performed with lower than expected predicted mortality. Redo-SAVR was associated with increased morbidity compared to VIV-TAVR, but improved valve function and hemodynamics. Differences in long term valve durability and patient survival between these two therapies are yet to be determined.