July 27, 2020
Valve-in-Valve TAVR Compared With Redo SAVR in Study in France
July 27, 2020—In Journal of the American College of Cardiology (JACC), Pierre Deharo, MD, et al published findings from a study that analyzed the outcomes of valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) versus redo surgical aortic valve replacement (SAVR) at a nationwide level in France (2020;76:489-499).
VIV TAVR was observed to be associated with better short-term outcomes than redo SAVR and major cardiovascular outcomes were not different between the two treatments during long-term follow-up, concluded the investigators in JACC.
The study is based on the French administrative hospital-discharge database. Investigators 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. A total of 4,327 patients were found in the database. After matching on baseline characteristics, 717 patients were analyzed in each arm.
In JACC, the investigators reported the following findings:
- 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 [OR], 0.62; 95% CI, 0.44-0.88; P = .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 two groups (OR, 1.18; 95% CI, 0.99-1.41; P = .26).
- Rehospitalization for heart failure and pacemaker implantation were more frequently reported in the VIV TAVR group.
- There was a time-dependent interaction between all-cause and cardiovascular mortality following VIV TAVR (P-interaction < .05).