Author + information
- Received January 22, 2020
- Revision received June 2, 2020
- Accepted June 3, 2020
- Published online July 27, 2020.
- Pierre Deharo, PhDa,b,∗ (, )@deharo_pierre,
- Arnaud Bisson, MDc,
- Julien Herbert, MDc,d,
- Thibaud Lacour, MDc,d,
- Christophe Saint Etienne, MDc,
- Alizée Porto, MDe,
- Alexis Theron, MDe,
- Frederic Collart, MDb,e,
- Thierry Bourguignon, PhDf,
- Thomas Cuisset, PhDa,b and
- Laurent Fauchier, PhDc
- aDépartement de Cardiologie, CHU Timone, Marseille, France
- bAix Marseille Univ, Inserm, Inra, C2VN, Marseille, France
- cService de Cardiologie, Centre Hospitalier Trousseau, Tours, France
- dService d'information médicale, Unité d’épidémiologie hospitalière régionale, Université de Tours, Tours, France
- eDépartement de Chirurgie Cardiaque, CHU Timone, Marseille, France
- fService de Chirurgie Cardiaque, Centre Hospitalier Universitaire, Tours, France
- ↵∗Address for correspondence:
Dr. Pierre Deharo, Service de Cardiologie, CHU Timone, Marseille 13005, France.
Background Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) and redo surgical aortic valve replacement (SAVR) represent the 2 treatments for aortic bioprosthesis failure. Clinical comparison of both therapies remains limited by the number of patients analyzed.
Objectives The purpose of this study was to analyze the outcomes of VIV TAVR versus redo SAVR at a nationwide level in France.
Methods Based on the French administrative hospital-discharge database, the study collected information for patients treated for aortic bioprosthesis failure with isolated VIV TAVR or redo SAVR between 2010 and 2019. Propensity score matching was used for the analysis of outcomes.
Results A total of 4,327 patients were found in the database. After matching on baseline characteristics, 717 patients were analyzed in each arm. At 30 days, VIV TAVR was associated with lower rates of the composite of all-cause mortality, all-cause stroke, myocardial infarction, and major or life-threatening bleeding (odds ratio: 0.62; 95% confidence interval: 0.44 to 0.88; p = 0.03). During follow-up (median 516 days), the combined endpoint of cardiovascular death, all-cause stroke, myocardial infarction, or rehospitalization for heart failure was not different between the 2 groups (odds ratio: 1.18; 95% confidence interval: 0.99 to 1.41; p = 0.26). Rehospitalization for heart failure and pacemaker implantation were more frequently reported in the VIV TAVR group. A time-dependent interaction between all-cause and cardiovascular mortality following VIV TAVR was reported (p-interaction <0.05).
Conclusions VIV TAVR was observed to be associated with better short-term outcomes than redo SAVR. Major cardiovascular outcomes were not different between the 2 treatments during long-term follow-up.
Dr. Etienne has received honoraria from Abbott and Biotronik. Dr. Bourguignon has served as a consultant for Edwards Lifesciences. Dr. Fauchier has served as a consultant or performed speaker activities for Bayer, Bristol-Myers Squibb/Pfizer, Boehringer Ingelheim, Medtronic, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received January 22, 2020.
- Revision received June 2, 2020.
- Accepted June 3, 2020.
- 2020 American College of Cardiology Foundation
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