Interventional versus Surgical Treatment of Degenerated Freestyle Prosthesis

Abstract

Background Bioprosthetic stentless aortic valves may degenerate over time and will require replacement. This study aimed to evaluate early- and mid-term outcomes after isolated surgical redo aortic valve replacement (redo-SAVR) and transcatheter valve-in-valve implantation (TAVI-VIV) for degenerated stentless Freestyle bioprostheses.

Methods We reviewed records of 56 patients at a single center. Overall, 37 patients (66.1%) received TAVI-VIV and 19 (33.9%) received redo-SAVR.

Results Thirty-day survival was similar in both groups (100%). One-year survival was comparable between groups (97.3% in TAVI-VIV and 100% in redo-SAVR, p = 1.0). The difference in mid-term survival after adjusting for age and EuroScore II was not significant (p = 0.41). The incidence of pacemaker implantation after TAVI-VIV was higher than after redo-SAVR (19.4% vs. 0%, p = 0.08).

Conclusion The 30-day and 1-year survival rates after both procedures were outstanding, irrespective of baseline characteristics. Isolated redo-SAVR should be favored in young patients, as the pacemaker implantation rate is lower. TAVI-VIV for degenerated Freestyle prosthesis can be a method of choice in elderly patients and those with high operative risk.

Keywords

xenograft - reoperation - heart valve - percutaneous (TAVI) - heart valve surgery - aortic valve and root

• References

• 1 Dumesnil JG, LeBlanc MH, Cartier PC. et al. Hemodynamic features of the freestyle aortic bioprosthesis compared with stented bioprosthesis. Ann Thorac Surg 1998; 66 (6, Suppl): S130-S133
• 2 Pibarot P, Dumesnil JG, Jobin J, Cartier P, Honos G, Durand LG. Hemodynamic and physical performance during maximal exercise in patients with an aortic bioprosthetic valve: comparison of stentless versus stented bioprostheses. J Am Coll Cardiol 1999; 34 (05) 1609-1617
• 3 Perez de Arenaza D, Lees B, Flather M. et al; ASSERT (Aortic Stentless versus Stented valve assessed by Echocardiography Randomized Trial) Investigators. Randomized comparison of stentless versus stented valves for aortic stenosis: effects on left ventricular mass. Circulation 2005; 112 (17) 2696-2702
• 4 Albert A, Florath I, Rosendahl U. et al. Effect of surgeon on transprosthetic gradients after aortic valve replacement with Freestyle stentless bioprosthesis and its consequences: a follow-up study in 587 patients. J Cardiothorac Surg 2007; 2: 40
• 5 Mohammadi S, Tchana-Sato V, Kalavrouziotis D. et al. Long-term clinical and echocardiographic follow-up of the Freestyle stentless aortic bioprosthesis. Circulation 2012; 126 (11, Suppl 1): S198-S204
• 6 Bach DS, Kon ND. Long-term clinical outcomes 15 years after aortic valve replacement with the Freestyle stentless aortic bioprosthesis. Ann Thorac Surg 2014; 97 (02) 544-551
• 7 Kappetein AP, Head SJ, Généreux P. et al; Valve Academic Research Consortium (VARC)-2. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2). Eur J Cardiothorac Surg 2012; 42 (05) S45-S60
• 8 Grubitzsch H, Zobel S, Christ T. et al. Redo procedures for degenerated stentless aortic xenografts and the role of valve-in-valve transcatheter techniques. Eur J Cardiothorac Surg 2017; 51 (04) 653-659
• 9 Schneider AW, Hazekamp MG, Versteegh MIM. et al. Reinterventions after freestyle stentless aortic valve replacement: an assessment of procedural risks. Eur J Cardiothorac Surg 2019; 56 (06) 1117-1123
• 10 Spaziano M, Mylotte D, Thériault-Lauzier P. et al. Transcatheter aortic valve implantation versus redo surgery for failing surgical aortic bioprostheses: a multicentre propensity score analysis. EuroIntervention 2017; 13 (10) 1149-1156
• 11 Sang SLW, Beute T, Heiser J, Berkompas D, Fanning J, Merhi W. Early outcomes for valve-in-valve transcatheter aortic valve replacement in degenerative freestyle bioprostheses. Semin Thorac Cardiovasc Surg 2018; 30 (03) 262-268
• 12 Duncan A, Moat N, Simonato M. et al. Outcomes following transcatheter aortic valve replacement for degenerative stentless versus stented bioprostheses. JACC Cardiovasc Interv 2019; 12 (13) 1256-1263
• 13 Yang B, Patel HJ, Norton EL. et al. Aortic valve reoperation after stentless bioprosthesis: short- and long-term outcomes. Ann Thorac Surg 2018; 106 (02) 521-525
• 14 Borger MA, Prasongsukarn K, Armstrong S, Feindel CM, David TE. Stentless aortic valve reoperations: a surgical challenge. Ann Thorac Surg 2007; 84 (03) 737-743 , discussion 743–744
• 15 Miller M, Snyder M, Horne BD. et al. Transcatheter aortic valve-in-valve replacement for degenerated stentless bioprosthetic aortic valves: results of a multicenter retrospective analysis. JACC Cardiovasc Interv 2019; 12 (13) 1217-1226
• 16 Finch J, Roussin I, Pepper J. Failing stentless aortic valves: redo aortic root replacement or valve in a valve?. Eur J Cardiothorac Surg 2013; 43 (03) 495-504
• 17 Deharo P, Bisson A, Herbert J. et al. Transcatheter valve-in-valve aortic valve replacement as an alternative to surgical re-replacement. J Am Coll Cardiol 2020; 76 (05) 489-499
• 18 Kerola T, Eranti A, Aro AL. et al. Risk factors associated with atrioventricular block. JAMA Netw Open 2019; 2 (05) e194176
• 19 Luc JGY, Shanks M, Tyrrell BD, Welsh RC, Butler CR, Meyer SR. Transcatheter valve-in-valve: a cautionary tale. Ann Thorac Surg 2016; 102 (03) e211-e213