BIOMAT Database Logo BIOMAT Database Logo

Redo Surgical Aortic Valve Replacement After Prior Transcatheter Versus Surgical Aortic Valve Replacement. 2023

Robert B Hawkins, and G Michael Deeb, and Devraj Sukul, and Himanshu J Patel, and Sarah K Gualano, and Stanley J Chetcuti, and P Michael Grossman, and Gorav Ailawadi, and Shinichi Fukuhara
Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.

Aortic stenosis treatment should consider risks and benefits for lifetime management. Although the feasibility of redo transcatheter aortic valve replacement (TAVR) remains unclear, concerns are emerging regarding reoperation after TAVR. The authors sought to define comparative risk of surgical aortic valve replacement (SAVR) after prior TAVR or SAVR. Data on patients undergoing bioprosthetic SAVR after TAVR and/or SAVR were extracted from the Society of Thoracic Surgeons Database (2011-2021). Overall and isolated SAVR cohorts were analyzed. The primary outcome was operative mortality. Risk adjustment using hierarchical logistic regression as well as propensity score matching for isolated SAVR cases were performed. Of 31,106 SAVR patients, 1,126 had prior TAVR (TAVR-SAVR), 674 had prior SAVR and TAVR (SAVR-TAVR-SAVR), and 29,306 had prior SAVR (SAVR-SAVR). Yearly rates of TAVR-SAVR and SAVR-TAVR-SAVR increased over time, whereas SAVR-SAVR was stable. The TAVR-SAVR patients were older, with higher acuity, and with greater comorbidities than other cohorts. The unadjusted operative mortality was highest in the TAVR-SAVR group (17% vs 12% vs 9%, respectively; P < 0.001). Compared with SAVR-SAVR, risk-adjusted operative mortality was significantly higher for TAVR-SAVR (OR: 1.53; P = 0.004), but not SAVR-TAVR-SAVR (OR: 1.02; P = 0.927). After propensity score matching, operative mortality of isolated SAVR was 1.74 times higher for TAVR-SAVR than SAVR-SAVR patients (P = 0.020). The number of post-TAVR reoperations is increasing and represent a high-risk population. Yet even in isolated SAVR cases, SAVR after TAVR is independently associated with increased risk of mortality. Patients with life expectancy beyond a TAVR valve and unsuitable anatomy for redo-TAVR should consider a SAVR-first approach.

UI MeSH Term Description Entries
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001021 Aortic Valve The valve between the left ventricle and the ascending aorta which prevents backflow into the left ventricle. Aortic Valves,Valve, Aortic,Valves, Aortic
D001024 Aortic Valve Stenosis A pathological constriction that can occur above (supravalvular stenosis), below (subvalvular stenosis), or at the AORTIC VALVE. It is characterized by restricted outflow from the LEFT VENTRICLE into the AORTA. Aortic Stenosis,Aortic Valve Stenoses,Stenoses, Aortic,Stenoses, Aortic Valve,Stenosis, Aortic,Stenosis, Aortic Valve,Valve Stenoses, Aortic,Valve Stenosis, Aortic
D012307 Risk Factors An aspect of personal behavior or lifestyle, environmental exposure, inborn or inherited characteristic, which, based on epidemiological evidence, is known to be associated with a health-related condition considered important to prevent. Health Correlates,Risk Factor Scores,Risk Scores,Social Risk Factors,Population at Risk,Populations at Risk,Correlates, Health,Factor, Risk,Factor, Social Risk,Factors, Social Risk,Risk Factor,Risk Factor Score,Risk Factor, Social,Risk Factors, Social,Risk Score,Score, Risk,Score, Risk Factor,Social Risk Factor
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D018570 Risk Assessment The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988) Assessment, Risk,Benefit-Risk Assessment,Risk Analysis,Risk-Benefit Assessment,Health Risk Assessment,Risks and Benefits,Analysis, Risk,Assessment, Benefit-Risk,Assessment, Health Risk,Assessment, Risk-Benefit,Benefit Risk Assessment,Benefit-Risk Assessments,Benefits and Risks,Health Risk Assessments,Risk Analyses,Risk Assessment, Health,Risk Assessments,Risk Benefit Assessment,Risk-Benefit Assessments
D019918 Heart Valve Prosthesis Implantation Surgical insertion of synthetic material to repair injured or diseased heart valves. Implantation, Heart Valve Prosthesis
D065467 Transcatheter Aortic Valve Replacement Surgical treatment for severe AORTIC VALVE STENOSIS. Transcatheter aortic valve replacement (TAVR) is used as an alternative option in patients who are deemed at high risk or inoperable for traditional open-heart surgery. Transcatheter Aortic Valve Implantation

Related Publications

Robert B Hawkins, and G Michael Deeb, and Devraj Sukul, and Himanshu J Patel, and Sarah K Gualano, and Stanley J Chetcuti, and P Michael Grossman, and Gorav Ailawadi, and Shinichi Fukuhara
Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo Surgical Aortic Valve Replacement.
April 2021, JACC. Cardiovascular interventions,
Robert B Hawkins, and G Michael Deeb, and Devraj Sukul, and Himanshu J Patel, and Sarah K Gualano, and Stanley J Chetcuti, and P Michael Grossman, and Gorav Ailawadi, and Shinichi Fukuhara
Redo-aortic valve replacement in prior stentless prosthetic aortic valves: Transcatheter versus surgical approach.
January 2022, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions,
Robert B Hawkins, and G Michael Deeb, and Devraj Sukul, and Himanshu J Patel, and Sarah K Gualano, and Stanley J Chetcuti, and P Michael Grossman, and Gorav Ailawadi, and Shinichi Fukuhara
Valve-in-valve transcatheter aortic valve replacement versus isolated redo surgical aortic valve replacement.
July 2023, The Journal of thoracic and cardiovascular surgery,
Robert B Hawkins, and G Michael Deeb, and Devraj Sukul, and Himanshu J Patel, and Sarah K Gualano, and Stanley J Chetcuti, and P Michael Grossman, and Gorav Ailawadi, and Shinichi Fukuhara
Reply: Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo Surgical Aortic Valve Replacement.
April 2021, JACC. Cardiovascular interventions,
Robert B Hawkins, and G Michael Deeb, and Devraj Sukul, and Himanshu J Patel, and Sarah K Gualano, and Stanley J Chetcuti, and P Michael Grossman, and Gorav Ailawadi, and Shinichi Fukuhara
Valve-in-Valve Transcatheter Implantation Versus Redo Surgical Aortic Valve Replacement.
May 2020, The American journal of cardiology,
Robert B Hawkins, and G Michael Deeb, and Devraj Sukul, and Himanshu J Patel, and Sarah K Gualano, and Stanley J Chetcuti, and P Michael Grossman, and Gorav Ailawadi, and Shinichi Fukuhara
Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo Surgical Aortic Valve Replacement: An Updated Meta-Analysis.
January 2021, JACC. Cardiovascular interventions,
Robert B Hawkins, and G Michael Deeb, and Devraj Sukul, and Himanshu J Patel, and Sarah K Gualano, and Stanley J Chetcuti, and P Michael Grossman, and Gorav Ailawadi, and Shinichi Fukuhara
Meta-analysis of Valve-in-Valve Transcatheter versus Redo Surgical Aortic Valve Replacement.
June 2019, The Thoracic and cardiovascular surgeon,
Robert B Hawkins, and G Michael Deeb, and Devraj Sukul, and Himanshu J Patel, and Sarah K Gualano, and Stanley J Chetcuti, and P Michael Grossman, and Gorav Ailawadi, and Shinichi Fukuhara
Transcatheter aortic valve implantation or surgical aortic valve replacement as redo procedure after prior coronary artery bypass grafting.
October 2011, The Annals of thoracic surgery,
Robert B Hawkins, and G Michael Deeb, and Devraj Sukul, and Himanshu J Patel, and Sarah K Gualano, and Stanley J Chetcuti, and P Michael Grossman, and Gorav Ailawadi, and Shinichi Fukuhara
Isolated Redo Aortic Valve Replacement Versus Valve-in-Valve Transcatheter Valve Replacement.
August 2021, The Annals of thoracic surgery,
Robert B Hawkins, and G Michael Deeb, and Devraj Sukul, and Himanshu J Patel, and Sarah K Gualano, and Stanley J Chetcuti, and P Michael Grossman, and Gorav Ailawadi, and Shinichi Fukuhara
Redo Surgical Aortic Valve Replacement in the Era of Transcatheter Aortic Valve Replacement.
October 2023, The Annals of thoracic surgery,
Copied contents to your clipboard!