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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Thorac+Dis
2015 ; 7
(9
): 1494-500
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gab.com Text
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English Wikipedia
Redo aortic valve surgery versus transcatheter valve-in-valve implantation for
failing surgical bioprosthetic valves: consecutive patients in a single-center
setting
#MMPMID26543594
Erlebach M
; Wottke M
; Deutsch MA
; Krane M
; Piazza N
; Lange R
; Bleiziffer S
J Thorac Dis
2015[Sep]; 7
(9
): 1494-500
PMID26543594
show ga
BACKGROUND: Due to a considerable rise in bioprosthetic as opposed to mechanical
valve implantations, an increase of patients presenting with failing
bioprosthetic surgical valves in need of a reoperation is to be expected. Redo
surgery may pose a high-risk procedure. Transcatheter aortic valve-in-valve
implantation is an innovative, less-invasive treatment alternative for these
patients. However, a comprehensive evaluation of the outcome of consecutive
patients after a valve-in-valve TAVI [transcatheter aortic valve-in-surgical
aortic valve (TAV-in-SAV)] as compared to a standard reoperation [surgical aortic
valve redo-operation (SAV-in-SAV)] has not yet been performed. The goal of this
study was to compare postoperative outcomes after TAV-in-SAV and SAV-in-SAV in a
single center setting. METHODS: All SAV-in-SAV and TAV-in-SAV patients from
January 2001 to October 2014 were retrospectively reviewed. Patients with
previous mechanical or transcatheter valves, active endocarditis and concomitant
cardiac procedures were excluded. Patient characteristics, preoperative data,
post-procedural complications, and 30-day mortality were collected from a
designated database. Mean values ± SD were calculated for all continuous
variables. Counts and percentages were calculated for categorical variables. The
Chi-square and Fisher exact tests were used to compare categorical variables.
Continuous variables were compared using the t-test for independent samples. A
2-sided P value <0.05 was considered statistically significant. RESULTS: A total
of 102 patients fulfilled the inclusion criteria, 50 patients (49%) underwent a
transcatheter valve-in-valve procedure, while 52 patients (51%) underwent
redo-surgery. Patients in the TAV-in-SAV group were significantly older, had a
higher mean logistic EuroSCORE and exhibited a lower mean left ventricular
ejection fraction than patients in the SAV-in-SAV group (78.1±6.7 vs. 66.2±13.1,
P<0.001; 27.4±18.7 vs. 14.4±10, P<0.001; and 49.8±13.1 vs. 56.7±15.8, P=0.019
respectively). Postoperative pacemaker implantation and chest tube output were
higher in the SAV-in-SAV group compared to the TAV-in-SAV group [11 (21%) vs. 3
(6%), P=0.042 and 0.9±1.0 vs. 0.6±0.9, P=0.047, respectively]. There was no
significant difference in myocardial infarction, stroke or dialysis
postoperatively. Thirty-day mortality was not significantly different between the
two groups [TAV-in-SAV2 (4%) vs. SAV-in-SAV0, P=0.238]. Kaplan-Meier (KM) 1-year
survival was significantly lower in the TAV-in-SAV group than in the SAV-in-SAV
group (83% vs. 96%, P<0.001). CONCLUSIONS: The present investigation shows that
both groups, irrespective of different baseline comorbidities, show very good
early clinical outcomes. While redo surgery is still the standard of care, a
subgroup of patients may profit from the transcatheter valve-in-valve procedure.