Supervisors info:
Κυριάκος Δημητριάδης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γεράσιμος Σιάσος, Καθηγητής και Πρύτανης, Ιατρική Σχολή, ΕΚΠΑ
Εμμανουήλ Βαβουρανάκης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
INTRODUCTION – BACKGROUND
Surgical bioprosthetic valve degeneration is considered a dangerous clinical scenario,
which will inevitably lead in the search of treatment with reintervention. The option of
resolving this issue with minimally invasive ways is possible due to the rapidly evolving
transcatheter techniques, especially reguarding aortic bioprostheses, although with the
emergence of the following question: redo surgical aortic valve replacement (re-SAVR)
or valve-in-valve transcatheter aortic valve implantation (ViV-TAVI)?
MATERIAL AND METHODS
The majority of data is resulting from observational studies, while the abscence of
randomized clinical trials is limiting the availability of information on the issue.
However, decently reliable outcomes can come forth from 7 meta-analyses that have been conducted from 2017 until today. These meta-analyses included 21 observational studies in total (retrospective and prospective) from USA, UK, France, Germany and Canada involving collectively 18.648 patients. Patients with transcatheter initial bioprosthetic aortic valve were excluded from the study. Furthermore, patients were divided in two groups, ViV-TAVI and re-SAVR. The primary clinical outcomes were all-cause mortality in 30 days and after 3 months, while, secondarily, hospital length of stay, risk of
postinterventional pacemaker implantation and risk of vascular, ischemic, hemorrhagic
and renal complications were assessed. Finally, mean pressure gradient values after the
procedure, as well as the risk of paravalvular leak (PVL) and patient-prosthesis mismatch
(PPM) were also assessed.
RESULTS
Overall, patients of ViV-TAVI group exhibited lower short-term mortality and shorter
hospital length of stay, while showing lower risk of pacemaker implantation, bleeding and
renal failure. No significant differences were noted between the two groups reguarding
mid-term mortality and risk of vascular/ischemic complications. On the other hand,
patients of re-SAVR group showed lower mean pressure gradient values after the
procedure, as well as lower risk of PVL and PPM.
CONCLUSIONS
ViV-TAVI represents an excellent alternative option for the treatment of degenerated
surgical aortic bioprostheses, epsecially for inoperable or high-risk patients, accompanied
by lower all-cause mortality in 30 days. Future conduction of randomized clinical trials is
of utmost importance, as it will provide even more reliable outcomes.
Keywords:
Degeneration, Aortic, Bioprosthetic, TAVI, SAVR
