Redo Surgical Aortic Valve Replacement versus Valve-In-Valve Transcatheter Aortic Valve Implantation: A Systematic Review and Reconstructed Time-To-Event Meta-Analysis

Francesco Formica; Alan Gallingani; Domenico Tuttolomondo; Daniel Hernandez-Vaquero; Stefano D'Alessandro; Claudia Pattuzzi; Mevlüt Çelik; Gurmeet Singh; Evelina Ceccato; Giampaolo Niccoli; Roberto Lorusso; Francesco Nicolini

doi:10.3390/jcm12020541

Redo Surgical Aortic Valve Replacement versus Valve-In-Valve Transcatheter Aortic Valve Implantation: A Systematic Review and Reconstructed Time-To-Event Meta-Analysis

J Clin Med. 2023 Jan 9;12(2):541. doi: 10.3390/jcm12020541.

Authors

Affiliations

¹ Department of Medicine and Surgery, University of Parma, 43124 Parma, Italy.
² Cardiac Surgery Clinic, University Hospital of Parma, Via Gramsci 14, 43125 Parma, Italy.
³ Cardiology Unit, University Hospital of Parma, Via Gramsci 14, 43125 Parma, Italy.
⁴ Cardiac Surgery Department, Hospital Universitario Central de Asturias, 33004 Oviedo, Spain.
⁵ Cardiac Surgery Unit, San Giovanni Bosco Hospital, 10144 Turin, Italy.
⁶ Department of Cardiothoracic Surgery, Erasmus University Medical Center, 3062 Rotterdam, The Netherlands.
⁷ Division of Cardiac Surgery, Department of Critical Care Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB 11220, Canada.
⁸ Medical Library, University of Parma, 43124 Parma, Italy.
⁹ Cardiovascular Research Institute Maastricht (CARIM), 6200 Maastricht, The Netherlands.

Abstract

Objective. Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) has emerged as a useful alternative intervention to redo-surgical aortic valve replacement (Redo-SVAR) for the treatment of degenerated bioprosthesis valve. However, there is no robust evidence about the long-term outcome of both treatments. The aim of this meta-analysis was to analyze the long-term outcomes of Redo-SVAR versus ViV-TAVI by reconstructing the time-to-event data. Methods. The search strategy consisted of a comprehensive review of relevant studies published between 1 January 2000 and 30 September 2022 in three electronic databases, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE. Relevant studies were retrieved for the analysis. The primary endpoint was the long-term mortality for all death. The comparisons were made by the Cox regression model and by landmark analysis and a fully parametric model. A random-effect method was applied to perform the meta-analysis. Results. Twelve studies fulfilled the eligibility criteria and were included in the final analysis. A total of 3547 patients were included. Redo-SAVR group included 1783 patients, and ViV-TAVI included 1764 subjects. Redo-SAVR showed a higher incidence of all-cause mortality within 30-days [Hazard ratio (HR) 2.12; 95% CI = 1.49−3.03; p < 0.0001)], whereas no difference was observed between 30 days and 1 year (HR = 1.03; 95% CI = 0.78−1.33; p = 0.92). From one year, Redo-SAVR showed a longer benefit (HR = 0.52; 95% CI = 0.40−0.67; p < 0.0001). These results were confirmed for cardiovascular death (HR = 2.04; 95% CI = 1.29−3.22; p = 0.001 within one month from intervention; HR = 0.35; 95% CI = 0.18−0.71; p = 0.003 at 4-years follow-up). Conclusions. Although the long-term outcomes seem similar between Redo-SAVR and ViV-TAVI at a five-year follow-up, ViV-TAVI shows significative lower mortality within 30 days. This advantage disappeared between 30 days and 1 year and reversed in favor of redo-SAVR 1 year after the intervention.

Keywords: biological prosthesis valve degeneration; long-term outcome; meta-analysis; redo surgical aortic valve replacement; valve-in-valve transcatheter aortic valve implantation.

Publication types

Review

Grants and funding

This research received no external funding.