Abstract
Objective The objective of this study was to determine whether valve-in-valve transcatheter
aortic valve implantation (VIV-TAVI) is associated with better survival than redo
surgical aortic valve replacement (SAVR) in patients with degenerated aortic valve
bioprostheses, and we performed a meta-analysis of comparative studies.
Methods To identify all comparative studies of VIV-TAVI versus redo SAVR; MEDLINE, Embase,
and the Cochrane Central Register of Controlled Trials were searched through October
2017. For each study, data regarding all-cause mortality in both the VIV-TAVI and
redo SAVR groups were used to generate odds ratios (ORs). To assess selection bias,
we generated ORs and (standardized) mean differences (MDs) for baseline characteristics.
Study-specific estimates were combined in the random-effects model.
Results Of 446 potentially relevant articles screened initially, 6 reports of retrospective
comparative studies enrolling a total of 498 patients were identified. Pooled analyses
of baseline characteristics demonstrated no statistically significant differences
in the proportion of women, patients with diabetes mellitus, patients with coronary
artery disease, and patients with baseline New York Heart Association functional class
of ≥III; baseline ejection fraction; and predicted mortality between the VIV-TAVI
and redo SAVR groups. Patients in the VIV-TAVI group, however, were significantly
older (MD, 4.20 years) and had undergone prior coronary artery bypass grafting more
frequently (OR, 2.19) than those in the redo SAVR group. Main pooled analyses demonstrated
no statistically significant differences in early (30 days or in-hospital) (OR, 0.91;
p = 0.83) and midterm (180 days–3 years) all-cause mortalities (OR, 1.42; p = 0.21) between the VIV-TAVI and redo SAVR groups.
Conclusion In patients with degenerated aortic valve bioprostheses, especially elderly or high-risk
patients, VIV-TAVI could be a safe, feasible alternative to redo SAVR. The lack of
randomized data and differences in baseline characteristics in the present analysis
emphasize the need for prospective randomized trials.
Keywords
degenerated aortic valve bioprostheses - meta-analysis - redo surgical aortic valve
replacement - valve-in-valve transcatheter aortic valve implantation
