Transcatheter valve-in-valve versus redo surgical aortic valve replacement for the treatment of degenerated bioprosthetic aortic valve: A systematic review and meta-analysis
Derrick Y. Tam MD
Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
Search for more papers by this authorThin X. Vo MD, MSc
Division of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
Search for more papers by this authorHarindra C. Wijeysundera MD, PhD
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
Search for more papers by this authorDanny Dvir MD
Division of Cardiology Department of Medicine, University of Washington Medical Centre, Seattle, Washington
Search for more papers by this authorJan O. Friedrich MD, PhD
Critical Care and Medicine Departments, St. Michael's Hospital University of Toronto, Toronto, Canada
Search for more papers by this authorCorresponding Author
Stephen E. Fremes MD, MSc
Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
Correspondence Stephen E. Fremes MSc, MD, FRCSC, FACP, FACC, Professor of Surgery, Dr. Bernard S. Goldman Chair in Cardiovascular Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room H4 05, Toronto, ON, M4N 3M5. Email: [email protected]Search for more papers by this authorDerrick Y. Tam MD
Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
Search for more papers by this authorThin X. Vo MD, MSc
Division of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
Search for more papers by this authorHarindra C. Wijeysundera MD, PhD
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
Search for more papers by this authorDanny Dvir MD
Division of Cardiology Department of Medicine, University of Washington Medical Centre, Seattle, Washington
Search for more papers by this authorJan O. Friedrich MD, PhD
Critical Care and Medicine Departments, St. Michael's Hospital University of Toronto, Toronto, Canada
Search for more papers by this authorCorresponding Author
Stephen E. Fremes MD, MSc
Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
Correspondence Stephen E. Fremes MSc, MD, FRCSC, FACP, FACC, Professor of Surgery, Dr. Bernard S. Goldman Chair in Cardiovascular Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room H4 05, Toronto, ON, M4N 3M5. Email: [email protected]Search for more papers by this authorFunding information: The Ontario Ministry of Health Clinician Investigator's Program (Toronto, Ontario) (Dr. Tam). Distinguished Clinician Scientist Award for the Heart and Stroke Foundation of Canada (Ottawa, Canada) (Dr. Wijeysundera). The Bernard S. Goldman Chair in Cardiovascular Surgery (Toronto, Ontario) (Dr. Fremes)
Abstract
Objective
To determine the safety and efficacy of valve-in-valve transcatheter aortic valve replacement (ViV) versus redo surgical aortic valve replacement (SAVR) for the treatment of previously failed aortic bioprostheses.
Background
Valve-in-valve has emerged as a treatment option for patients with a failed aortic bioprosthesis. Evidence for safety and efficacy remains limited to small studies.
Methods
Medline and Embase were searched to 2017 for studies that directly compared ViV to redo SAVR. A random effects meta-analysis was performed.
Results
Four unadjusted (n = 298) and two propensity-matched (n = 200) observational studies were included. Valve-in-valve patients were 2.85-years older (P = 0.03) and were 23% higher in predicted mortality risk (ratio of means: 1.23, 95% confidence interval (95%CI): 1.02–1.48). There was no difference in peri-operative mortality (4.4% vs. 5.7%, P = 0.83;I2 = 0%) or late mortality, reported at median one year follow-up (incident rate ratio (IRR) 0.93, 95%CI: 0.74–1.16, P = 0.51, I2 = 0%) between ViV and redo SAVR. The incidence of permanent pacemaker implantation (8.3% vs 14.6%; P = 0.05;I2 = 0%) and dialysis (3.2% vs. 10.3%; P = 0.03; I2 = 0%) were lower in ViV. There was a reduction in the incidence of severe patient-prosthesis mismatch (3.3% vs 13.5%; P = 0.03; I2 = 0%) and mild or greater paravalvular leak (5.5% vs 21.1%; P = 0.03; I2 = 37%) in the redo SAVR group compared to ViV.
Conclusions
Despite higher predicted surgical risk of ViV patients, there was no difference in mortality but less permanent pacemaker implantation and dialysis compared to redo SAVR. Choice of treatment must be individualized for both anatomical and patient risk factors; in high risk patients with favorable previous prosthesis size, valve-in-valve may be preferred.
CONFLICT OF INTEREST
Nothing to report.
Supporting Information
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| ccd27686-sup-0003-suppinfo3.tiff572.9 KB | Supporting Information 3 |
| ccd27686-sup-0004-suppinfo4.tiff818.5 KB | Supporting Information 4 |
| ccd27686-sup-0005-suppinfo5.tiff553.1 KB | Supporting Information 5 |
| ccd27686-sup-0006-suppinfo6.tiff344.5 KB | Supporting Information 6 |
| ccd27686-sup-0007-suppinfo7.tiff545.1 KB | Supporting Information 7 |
| ccd27686-sup-0008-suppinfo8.tiff312.3 KB | Supporting Information 8 |
| ccd27686-sup-0009-suppinfo1.docx106.7 KB | Supporting Information Tables |
| ccd27686-sup-0010-suppinfo2.docx121.8 KB | Supporting Information Figures |
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References
- 1 Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ. Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients. N Engl J Med. 2011; 364(23): 2187–98.
- 2 Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S, PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010; 363(17): 1597–607.
- 3 Dvir D, Webb JG, Bleiziffer S, Pasic M, Waksman R, Kodali S, Barbanti M, Latib A, Schaefer U, Rodés-Cabau J, Treede H, Piazza N, Hildick-Smith D, Himbert D, Walther T, Hengstenberg C, Nissen H, Bekeredjian R, Presbitero P, Ferrari E, Segev A, de Weger A, Windecker S, Moat NE, Napodano M, Wilbring M, Cerillo AG, Brecker S, Tchetche D, Lefèvre T, De Marco F, Fiorina C, Petronio AS, Teles RC, Testa L, Laborde J-C, Leon MB, Kornowski R. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. JAMA 2014; 312: 162–170.
- 4 Forcillo J, Tsai LL, Thourani VH. Will transcatheter valve-in-valve become the standard for replacing the degenerative aortic valve bioprosthesis? Hold your horses, the jury is still out. J Thorac Cardiovasc Surg 2015; 150: 1568–1569. Dec
- 5 Santarpino G, Pollari F, Fischlein T. Aortic valve stenosis in redo operations in octogenarians: transcatheter aortic valve implantation or surgical intervention? that is the question. Ann Thorac Surg 2015; 100: 378–379. Jul
- 6 Dvir D, Leipsic J, Blanke P, Ribeiro HB, Kornowski R, Pichard A, Rodes-Cabau J, Wood DA, Stub D, Ben-Dor I, Maluenda G, Makkar RR, Webb JG. Coronary obstruction in transcatheter aortic valve-in-valve implantation: preprocedural evaluation, device selection, protection, and treatment. Circ Cardiovasc Interv 2015; 8: e002079. Jan
- 7 Dvir D. Treatment of small surgical valves: clinical considerations for achieving optimal results in valve-in-valve procedures. JACC 2015; 8: 2034–2036. Dec 28
- 8 Kaneko T, Vassileva CM, Englum B, Kim S, Yammine M, Brennan M, Suri RM, Thourani VH, Jacobs JP, Aranki S. Contemporary outcomes of repeat aortic valve replacement: a benchmark for transcatheter valve-in-valve procedures. Ann Thorac Surg 2015; 100: 1298–1304.
- 9 Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-Analysis of Observational Studies in Epidemiology (MOOSE) Group. JAMA 2000; 283: 2008–2012.
- 10 Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P, Montori V, Akl EA, Djulbegovic B, Falck-Ytter Y, Norris SL, Williams JW, Atkins D, Meerpohl J, Schünemann HJ. GRADE guidelines: 4. Rating the quality of evidence–study limitations (risk of bias). J Clin Epidemiol 2011; 64: 407–415. Apr
- 11 Friedrich JO, Adhikari NKJ, Beyene J. Ratio of means for analyzing continuous outcomes in meta-analysis performed as well as mean difference methods. J Clin Epidemiol 2011; 64: 556–564. May
- 12 Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014; 14: 135. Dec 19
- 13
Parmar MK,
Torri V,
Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 1998; 17: 2815–2834. Dec 30
10.1002/(SICI)1097-0258(19981230)17:24<2815::AID-SIM110>3.0.CO;2-8 CAS PubMed Web of Science® Google Scholar
- 14 Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0. The Cochrane Collaboration; 2011.
- 15 Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Br Med J 2003; 327: 557.
- 16 Silaschi M, Wendler O, Seiffert M, Castro L, Lubos E, Schirmer J, Blankenberg S, Reichenspurner H, Schäfer U, Treede H, MacCarthy P, Conradi L. Transcatheter valve-in-valve implantation versus redo surgical aortic valve replacement in patients with failed aortic bioprostheses. Interact Cardiovasc Thorac Surg 2017; 24: 63–70. Jan
- 17 Santarpino G, Pietsch L, Jessl J, Pfeiffer S, Pollari F, Pauschinger M, Fischlein T. Transcatheter aortic valve-in-valve implantation and sutureless aortic valve replacement: two strategies for one goal in redo patients. Minerva Cardioangiol. 2016; 64(6): 581–5.
- 18 Erlebach M, Wottke M, Deutsch M-A, Krane M, Piazza N, Lange R, Bleiziffer S. Redo aortic valve surgery versus transcatheter valve-in-valve implantation for failing surgical bioprosthetic valves: consecutive patients in a single-center setting. Journal of Thoracic Disease. 2015; 7(9): 1494–500.
- 19 Grubitzsch H, Zobel S, Christ T, Holinski S, Stangl K, Treskatsch S, Falk V, Laule M. Redo procedures for degenerated stentless aortic xenografts and the role of valve-in-valve transcatheter techniques. Eur J Cardiothorac Surg. 2017.
- 20 Grubitzsch H, Zobel S, Christ T, Holinski S, Stangl K, Treskatsch S, et al. Redo procedures for degenerated stentless aortic xenografts and the role of valve-in-valve transcatheter techniques†. Eur J Cardiothorac Surg. 2017.
- 21 Ejiofor JI, Yammine M, Harloff MT, McGurk S, Muehlschlegel JD, Shekar PS, Cohn LH, Shah P, Kaneko T. Reoperative surgical aortic valve replacement versus transcatheter valve-in-valve replacement for degenerated bioprosthetic aortic valves. Ann Thorac Surg 2016; 102: 1452–1458. Nov
- 22 Spaziano M, Mylotte D, Thériault-Lauzier P, De Backer O, Søndergaard L, Bosmans J, Debry N, Modine T, Barbanti M, Tamburino C, Sinning J-M, Grube E, Nickenig G, Mellert F, Bleiziffer S, Lange R, de Varennes B, Lachapelle K, Martucci G, Piazza N. Transcatheter aortic valve implantation versus redo surgery for failing surgical aortic bioprostheses: a multicentre propensity score analysis. EuroIntervention 2017; 13: 1149–1156.
- 23 Martin E, Dagenais F, Voisine P, Dumont E, Charbonneau E, Baillot R, Kalavrouziotis D, Mohammadi S. Surgical aortic valve replacement outcomes in the transcatheter era. J Thorac Cardiovasc Surg 2015; 150: 1582–1588.
- 24 Silaschi M, Conradi L, Treede H, Reiter B, Schaefer U, Blankenberg S, Reichenspurner H. Trends in surgical aortic valve replacement in more than 3,000 consecutive cases in the era of transcatheter aortic valve implantations. Thorac Cardiovasc Surg. Georg Thieme Verlag KG 2015; 64: 382–389.
- 25 Walther T, Rastan A, Falk V, Lehmann S, Garbade J, Funkat A, Mohr F, Gummert J. Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacement. Eur J Cardiothorac Surg 2006 ; 30: 15–19. Jul
- 26 Howell N, Keogh B, Barnet V, Bonser R, Graham T, Rooney S, Wilson I, Pagano D. Patient-prosthesis mismatch does not affect survival following aortic valve replacement. Eur J Cardiothorac Surg 2006 ; 30: 10–14. Jul
- 27 Seiffert M, Conradi L, Baldus S, Knap M, Schirmer J, Franzen O, Koschyk D, Meinertz T, Reichenspurner H, Treede H. Impact of patient-prosthesis mismatch after transcatheter aortic valve-in-valve implantation in degenerated bioprostheses. J Thorac Cardiovasc Surg 2012 ; 143: 617–624. Mar
- 28 Kukucka M, Pasic M, Dreysse S, Mladenow A, Habazettl H, Hetzer R, Unbehaun A. Patient-prosthesis mismatch after transapical aortic valve implantation: incidence and impact on survival. J Thorac Cardiovasc Surg 2013 ; 145: 391–397. Feb
- 29 Gozdek M, Raffa GM, Suwalski P, Kolodziejczak M, Anisimowicz L, Kubica J, Navarese EP, Kowalewski M, SIRIO-TAVI group. Comparative performance of transcatheter aortic valve-in-valve implantation versus conventional surgical redo aortic valve replacement in patients with degenerated aortic valve bioprostheses: systematic review and meta-analysis. Eur J Cardiothorac Surg. 2018; 53(3): 495–504.
- 30 Gozdek M, Raffa GM, Suwalski P, Kolodziejczak M, Anisimowicz L, Kubica J, et al. Comparative performance of transcatheter aortic valve-in-valve implantation versus conventional surgical redo aortic valve replacement in patients with degenerated aortic valve bioprostheses: systematic review and meta-analysis. Eur J Cardiothorac Surg. 2017.
- 31 Wang N, Tsai Y-C, Niles N, Tchantchaleishvili V, Eusanio MD, Yan TD, Phan K. Transcatheter valve-in-valve implantation versus reoperative conventional aortic valve replacement: a systematic review. J Thorac Disease 2016; 8: 3283–3293. Jan
- 32 Chen H-L, Liu K. Clinical outcomes for transcatheter valve-in-valve in treating surgical bioprosthetic dysfunction: A meta-analysis. Int J Cardiol 2016;1; 212: 138–141.
- 33 Sud M, Tam DY, Wijeysundera HC. The economics of transcatheter valve interventions. Can J Cardiol 2017; 33: 1091–1098. Sep
- 34 Wijeysundera HC, Li L, Braga V, Pazhaniappan N, Pardhan AM, Lian D, Leeksma A, Peterson B, Cohen EA, Forsey A, Kingsbury KJ. Drivers of healthcare costs associated with the episode of care for surgical aortic valve replacement versus transcatheter aortic valve implantation. Open Heart 2016; 3: e000468.
- 35 Onorati F, D'Onofrio A, Biancari F, Salizzoni S, De Feo M, Agrifoglio M, Aortic Valve Replacement in Redo-Scenarios: A Comparison Between Traditional Aortic Valve Replacement (TAVR) and Transapical-TAVR from Two Real-World Multicenter Registries. J Heart Valve Dis. 2015; 24(6): 669–78.
- 36 Tam DY, Vo TX, Wijeysundera HC, Ko DT, Rocha RV, Friedrich J, Fremes SE. Transcatheter vs surgical aortic valve replacement for aortic stenosis in low-intermediate risk patients: a meta-analysis. Can J Cardiol 2017; 33: 1171–1179. Sep
