Study Supports Safety and Efficacy of Valve-in-Valve TAVR
July 17, 2018—In a study comparing valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) with native valve (NV) TAVR, ViV TAVR was shown to be a safe and effective procedure in patients at high risk for repeat surgery who failed surgical aortic valve replacement (SAVR). The findings were published by E. Murat Tuzcu, MD, et al in Journal of the American College of Cardiology (JACC; 2018;72:370–382).
In the study, patients who underwent ViV TAVR (n = 1,150) were matched 1:2 (on sex, high or extreme risk, hostile chest or porcelain aorta, 5-m walk time, and Society of Thoracic Surgeons predicted risk of mortality for reoperation) to patients undergoing NV TAVR (n = 2,259).
Baseline characteristics, procedural data, and in-hospital outcomes were obtained from the Transcatheter Valve Therapy Registry. The 30-day and 1-year outcomes were obtained from linked Medicare administrative claims data.
As summarized in JACC, unadjusted analysis demonstrated lower 30-day mortality (2.9% vs 4.8%; P < .001), stroke (1.7% vs 3.0%; P = .003), and heart failure hospitalizations (2.4% vs 4.6%; P < .001) in the ViV TAVR compared with the NV TAVR group.
Adjusted analysis revealed lower 30-day mortality (hazard ratio [HR], 0.503; 95% confidence interval [CI], 0.302–0.839; P = .008), 1-year mortality (HR, 0.653; 95% CI, 0.505–0.844; P = .001), and hospitalization for heart failure (HR, 0.685; 95% CI, 0.5–0.939; P = .019) in the ViV TAVR group.
Patients in the ViV TAVR group had higher post-TAVR mean gradient (16 vs 9 mm Hg; P < .001) but less moderate or severe aortic regurgitation (3.5% vs 6.6%; P < .001). Post-TAVR gradients were highest in small SAVRs and stenotic SAVRs, reported the investigators in JACC.