Abstract
ObjectiveWe sought to investigate real-world outcomes of patients with degenerated biological aortic valve prostheses who had undergone valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) or reoperative surgical aortic valve replacement (redo-SAVR) in the Netherlands.MethodsPatients who had undergone ViV-TAVI or redo-SAVR for a degenerated biological aortic valve prosthesis in the Netherlands between January 2014 and December 2018 were eligible for this retrospective study. Patients with a prior homograft, active endocarditis or mechanical aortic valve prosthesis were excluded. Patients were matched using the propensity score. The primary endpoint was a composite of 30-day all-cause mortality and in-hospital postoperative stroke. Secondary endpoints were all-cause mortality at different time points, in-hospital postoperative stroke, pacemaker implantation and redo procedures within one year. Baseline characteristics and outcome data were collected from the Netherlands Heart Registration.ResultsFrom 16 cardiac centres, 653 patients were included in the study (374 ViV-TAVI and 279 redo-SAVR). European System for Cardiac Operative Risk Evaluation I (EuroSCORE I) was higher in ViV-TAVI patients (19.4, interquartile range (IQR) 13.3–27.9 vs 13.8, IQR 8.3–21.9, p < 0.01). After propensity score matching, 165 patients were matched with acceptable covariate balance. In the matched cohorts, the primary endpoint was not significantly different for ViV-TAVI and redo-SAVR patients (odds ratio 1.30, 95% confidence interval 0.57–3.02). Procedural, 30-day and 1‑year all-cause mortality rates, incidence of in-hospital postoperative stroke, pacemaker implantation and redo procedures within one year were also similar between cohorts.ConclusionPatients with degenerated aortic bioprostheses treated with ViV-TAVI or redo-SAVR have similar mortality and morbidity.Supplementary InformationThe online version of this article (10.1007/s12471-021-01608-0) contains supplementary material, which is available to authorized users.
Highlights
Stenotic aortic valve disease is one of the most common valve diseases in Western countries [1]
On behalf of the Netherlands Heart Registration (NHR) THI & cardiothoracic surgery Registration Committees, of which the members are listed in the Electronic Supplementary Material
We investigated all-cause mortality and morbidity of consecutive patients who had undergone ViV-transcatheter aortic valve implantation (TAVI) or redo-surgical aortic valve replacement (SAVR) in the Netherlands, based on data from the Netherlands Heart Registration (NHR; Nederlandse Hart Registratie)
Summary
Stenotic aortic valve disease is one of the most common valve diseases in Western countries [1]. It is present in roughly 5% of 65-year-olds and the prevalence increases even further with advancing age [1]. TAVI was used in inoperable patients and patients at very high surgical risk [3]. Patients with lower surgical risk are frequently younger and the long-term durability of surgical bioprosthetic valves has been well established, while similar long-term follow-up data of TAVI patients are not yet available [5,6,7]
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