Isolated Redo Aortic Valve Replacement Versus Valve-in-Valve Transcatheter Valve Replacement

Background. Clinical outcomes of redo surgical aortic valve replacement (redo-SAVR) compared with valve-in valve transcatheter aortic valve replacement (VIV-TAVR) are poorly understood. This study compared short-and midterm outcomes of patients undergoing isolated redoSAVR vs VIV-TAVR after previous SAVR. Methods. A single-institutional review of the initial use of VIV-TAVR from 2012 to 2019 identified 273 patients undergoing VIV-TAVR (n = 187) or redoSAVR (n = 86) after prior SAVR. Outcomes analysis included a univariate analysis and Kaplan-Meier survival analysis. Results. The Society of Thoracic Surgeons predicted risk of mortality was higher for VIV-TAVR (6.3%; inter quartile range [IQR], 3.6%-10.5%) vs redo-SAVR (4.2%; IQR, 2.4%-6.9%; P < .01). VIV-TAVR patients (76 years; IQR, 67.5-82.5 years) were older than redo-SAVR patients (64 years; IQR, 54-72; P < .01). Redo-SAVR and VIVTAVR had similar early mortality (1.2% vs 1.6%, P = .92). Two redo-SAVR (2.3%) and 3 VIV-TAVR patients (1.6%) died 4.8 +/- 0.5 years and 4.8 +/- 1.5 months after discharge, respectively. Redo-SAVR had an increased stroke rate (7.0% vs 1.1%, P = .02). Postoperative mean valve gradients were similar between VIV-TAVR (14 mm Hg; IQR, 9-21 mm Hg) and redo-SAVR patients (12 mm Hg; IQR, 8-20 mm Hg; P = .08). Postprocedure trans esophageal echocardiography showed at least mild aortic insufficiency for 24 VIV-TAVR patients (16%) and 2 redoSAVR patients (2.9%) (P = .01). The cumulative incidence of aortic valve reintervention was 5.2% for the redo-SAVR patients and 28.5% for the VIV-TAVR patients (P = .07). Conclusions. After previous SAVR, redo-SAVR and VIV-TAVR can both be performed with acceptable operative results. Despite treating a high-risk patient population, we found redo-SAVR and VIV-TAVR both carry similar operative outcomes. Improved valve hemodynamics were observed in redo-SAVR patients compared with VIV-TAVR patients. (Ann Thorac Surg 2021;112:539-45) (c) 2021 by The Society of Thoracic Surgeons