PMID- 25754372
OWN - NLM
STAT- MEDLINE
DCOM- 20160310
LR  - 20150529
IS  - 1569-9285 (Electronic)
IS  - 1569-9285 (Linking)
VI  - 20
IP  - 6
DP  - 2015 Jun
TI  - What is the best approach in a patient with a failed aortic bioprosthetic valve: 
      transcatheter aortic valve replacement or redo aortic valve replacement?
PG  - 837-43
LID - 10.1093/icvts/ivv037 [doi]
AB  - A best evidence topic in cardiac surgery was written according to a structured 
      protocol. The question addressed was whether transcatheter aortic valve-in-valve 
      replacement (viv-TAVR) or redo aortic valve replacement (rAVR) is the best 
      strategy in a patient with a degenerative bioprosthetic aortic valve. Altogether, 
      162 papers were found using the reported search, of which 12 represented the best 
      evidence to answer the question. The authors, journal, date, country of 
      publication, patient group, study type, outcomes and results of papers are 
      tabulated. The results of the studies provided interesting results. All the 
      studies are retrospective. Four papers reported the results of redo aortic valve 
      replacement in patients with failed aortic bioprosthetic valve, six papers 
      demonstrated their results with transcatheter aortic valve-in-valve replacement 
      for the same indication and two papers reported their propensity-matched analysis 
      of outcomes between viv-TAVR and rAVR in patients with previous cardiac surgery. 
      Thirty-day mortality for rAVR was 2.3-15.5% and 0-17% for viv-TAVR. For rAVR, 
      survival rate at 30 days was 83.6%, 76.1% at 1 year, 70.8% at 3 years, at 
      51.3-66% at 5 years, 61% at 8 years and 61.5% at 10 years. For viv-TAVR, the 
      overall Kaplan-Meier survival rate at 1 year was 83.2%. After viv-TAVR at 1 year, 
      86.2% of surviving patients were at New York Heart Association (NYHA) class I/II. 
      The complications after rAVR were stroke (4.6-5.8%), reoperation for bleeding 
      (6.9-9.7%), low-cardiac output syndrome (9.9%) whereas complications after 
      viv-TAVR at 30 days were major stroke (1.7%), aortic regurgitation of at least 
      moderate degree (25%), new permanent pacemaker implantation rate (0-11%), ostial 
      coronary obstruction (2%), need for implantation of a second device (5.7%) and 
      major vascular complications (9.2%). It is noteworthy to mention that there is a 
      valve-in-valve application that provides information to surgeons for choosing the 
      correct size of the TAVR valve. Transcatheter aortic valve-in-valve procedures 
      are clinically effective, at least in the short term, and could be an acceptable 
      approach in selected high-risk patients with degenerative bioprosthetic valves. 
      Redo AVR achieves acceptable medium and long-term results. Both techniques could 
      be seen as complementary approaches for high-risk patients.
CI  - (c) The Author 2015. Published by Oxford University Press on behalf of the European 
      Association for Cardio-Thoracic Surgery. All rights reserved.
FAU - Tourmousoglou, Christos
AU  - Tourmousoglou C
AD  - University of Ioannina Medical School, Ioannina, Greece 
      christostourmousoglou@hotmail.com.
FAU - Rao, Vivek
AU  - Rao V
AD  - Division of Cardiovascular Surgery, Peter Munk Cardiac Center, Toronto General 
      Hospital, University of Toronto, Toronto, Canada.
FAU - Lalos, Spiros
AU  - Lalos S
AD  - Department of Cardiothoracic Surgery, Hippokratio General Hospital, Athens, 
      Greece.
FAU - Dougenis, Dimitrios
AU  - Dougenis D
AD  - Department of Cardiothoracic Surgery, University Hospital of Patra, Patra, 
      Greece.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20150308
PL  - England
TA  - Interact Cardiovasc Thorac Surg
JT  - Interactive cardiovascular and thoracic surgery
JID - 101158399
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve/physiopathology/*surgery
MH  - Benchmarking
MH  - *Bioprosthesis
MH  - Cardiac Catheterization/adverse effects/*instrumentation/mortality
MH  - *Device Removal
MH  - Evidence-Based Medicine
MH  - Female
MH  - Heart Valve Diseases/diagnosis/mortality/physiopathology/*surgery
MH  - *Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/adverse 
      effects/*instrumentation/methods/mortality
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Prosthesis Design
MH  - Prosthesis Failure
MH  - Reoperation
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Aortic valve
OT  - Bioprosthesis
OT  - Failed
OT  - Implantation
EDAT- 2015/03/11 06:00
MHDA- 2016/03/11 06:00
CRDT- 2015/03/11 06:00
PHST- 2014/04/03 00:00 [received]
PHST- 2015/02/12 00:00 [accepted]
PHST- 2015/03/11 06:00 [entrez]
PHST- 2015/03/11 06:00 [pubmed]
PHST- 2016/03/11 06:00 [medline]
AID - ivv037 [pii]
AID - 10.1093/icvts/ivv037 [doi]
PST - ppublish
SO  - Interact Cardiovasc Thorac Surg. 2015 Jun;20(6):837-43. doi: 
      10.1093/icvts/ivv037. Epub 2015 Mar 8.