Isolated Redo-Aortic Valve Replacement versus Valve-in-Valve Transcatheter Valve Replacement.

BACKGROUND Clinical outcomes of redo surgical aortic valve replacement (SAVR) compared to Valve-in-Valve Transcatheter Aortic Valve Replacement (VIV-TAVR) are poorly understood. This study compared short and midterm outcomes of patients undergoing isolated redo-SAVR versus VIV-TAVR after previous SAVR. METHODS A single-institutional review of the initial use of VIV-TAVR from 2012-2019 identified 273 patients undergoing either VIV-TAVR (n=187) or redo-SAVR (n=86) after prior SAVR. Outcomes analysis included a univariate analysis and Kaplan Meier survival analysis. RESULTS Society of Thoracic Surgeons Predicted Risk of Mortality was higher for the VIV-TAVR (6.3%, IQR 3.6-10.5) versus redo-SAVR (4.2%, IQR 2.4-6.9, p<0.01). VIV-TAVR patients (76 years, IQR 67.5-82.5) were older than redo-SAVR patients (64 years, IQR 54-72, p<0.01). Redo-SAVR and VIV-TAVR had similar early mortality (1.2% vs 1.6%, p=0.92). Two (2.3%) redo-SAVR and 3 (1.6%) VIV-TAVR patients died 4.8±0.5 years and 4.8±1.5 months post-discharge respectively. Redo-SAVR had increased stroke rate (7.0% vs 1.1%, p=0.02). Post-operative mean valve gradients were similar between VIV-TAVR (14mmHg, IQR 9-21) and Redo-SAVR patients (12mmHg, IQR 8-20, p=0.08). Post-procedure TEE showed at least mild aortic insufficiency for 24 (16%) of VIV-TAVR patients and 2 (2.9%) of redo-SAVR patients (p=0.01). Cumulative incidence of aortic valve reintervention is 5.2% and 28.5% for the redo-SAVR and VIV-TAVR groups respectively, p=0.07. CONCLUSIONS Following previous SAVR, both redo-SAVR and VIV-TAVR can be performed with acceptable operative results. Despite treating a high-risk patient population, both redo-SAVR and VIV-TAVR carry similar operative outcomes. Improved valve hemodynamics were observed in redo-SAVR patients compared with VIV-TAVR patients.