Transcatheter Vs. Ministernotomy For Aortic Valve Replacement After Prosthetic Valve Failure
Vishal Shah, Oleg Orlov, Cinthia Orlov, Matthew Thomas, Roberto Rodriguez, Scott Goldman, Konstadinos Plestis.
Lankenau Medical Center, Philadelphia, PA, USA.
BACKGROUND: Transcatheter valve-in-valve implantation (TViV) has been recently proposed as an alternative to reoperative surgical aortic valve replacement for failing biological aortic valves. We compared results of patients undergoing TViV versus mini reoperative AVR (MIrAVR) after prosthetic valve failure. METHODS: From 2008 to 2017, 59 patients were treated for degenerated aortic prosthetic valves in our institution. Thirty-four (57.6%) patients underwent TViV and 25 (42.4%) patients underwent MIrAVR. Patients with prior CABG or active endocarditis were excluded. RESULTS: Mean age was higher (76±10 years vs. 63±11 years, p<0.001) in TViV group. There was no difference in hospital mortality (0% vs. 8%), stroke (0% vs 0%), renal insufficiency (0% vs. 12%), atrial fibrillation (8.8% vs. 20%) and permanent pacemaker implantation (8.8% vs. 16%) between TViV and MIrAVR respectively (p>0.05) (Table 1). Prolonged ventilation (5.9 % vs. 28%), intubation time (0.38 days vs. 0.61 days) and median length of stay (4.5 days vs. 6 days) were significantly less in TViV (p<0.05). Mean postoperative gradient was significantly lower (8.8±5.8 mm Hg vs. 12.8±3.9 mm Hg, p<0.001) in the TViV group compared to the MIrAVR group. One patient had mild and one had moderate postoperative PVL in the TViV group. None of the patients in the MIrAVR group had postoperative PVL (p=0.46). At approximately one year follow-up, mean gradient was 18.5±10.8 mm Hg and 16.2±6.7 mm Hg in TViV and MIrAVR groups respectively (p=0.70). Two patients had mild PVL in the TViV group and 1 patient had moderate PVL in the MIrAVR group (p=0.90). Survival at 1 year for TViV and MIrAVR was 100% and 87% respectively (p=0.30). CONCLUSIONS: TViV provides similar short-term outcomes to MIrAVR for prosthetic valve degeneration with lower postoperative gradients, blood utilization and hospital stay. However, long-term outcomes are necessary to confirm the durability of this approach.
LEGEND: TViV vs. MIrAVR 
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