Comparison Of Clinical And Hemodynamic Outcomes Between Redo Surgical Aortic Valve Replacement Versus Transcatheter Valve In Valve In Patient With Failed Aortic Bioprostheses

Introduction: Transcatheter valve-in-valve implantation (ViV) has emerged as an alternative to redo surgery (REDO) for the treatment of failed surgical aortic bioprostheses. However, there are few studies comparing clinical and hemodynamic outcomes between REDO and ViV in both the short- and long- term follow-up. Objective: The aim of this study was to compare hemodynamic and clinical outcomes between REDO and ViV. Methods: A total of 184 patients who underwent REDO or ViV at our institution between 2003 and 2017 were included in this study. Clinical and transthoracic echocardiography (TTE) data were collected for each patient. TTE was performed prior and after the reintervention and were retrospectively analyzed in an echocardiography core laboratory. An inverse propensity treatment weighting (IPTW) was used to compare outcomes between groups. Results: 104 patients underwent REDO and 80 underwent ViV. Prevalence of suboptimal valve hemodynamics (mean gradient ≥ 20 mmHg and/or ≥ moderate aortic regurgitation) following reintervention was higher in ViV group (29.8% vs. 61.3%, p<0.001), the rate of novel permanent pacemaker tended to be higher with REDO (10.6% vs. 3.8%, p=0.08). During a median follow-up of 5.0 (3.7-7.5) years, 60 patients died. There was a trend toward higher rate of 30-day mortality in the REDO vs. ViV group (8.6% vs. 2.5%, OR [95% CI]: 3.70[0.77-17.6], p=0.10) and a trend toward lower risk of long-term mortality in REDO (HR [95% CI]: 0.61[0.33-1.14], p=0.12). In multivariate cox proportional analysis adjusted for age, sex, EuroSCORE 2, ViV was significantly associated with increased risk of long-term mortality (HR [95% CI]: 2.28[1.25-4.15], p=0.03). Results were confirmed in IPTW analyses (30-day mortality in REDO vs. ViV: 3.39[3.25-3.53], p<0.001; long-term mortality: 0.70[0.69-0.71], p<0.001). Conclusions: ViV was associated with lower risk of 30-day but higher risk of long-term mortality compared to REDO.