Francesco Onorati1*, Augusto D’Onofrio2*, Fausto Biancari3, Stefano Salizzoni4, Marisa De Feo5, Marco Agrifoglio6, Giovanni Mariscalco7, Vincenzo Lucchetti8, Antonio Messina9, Francesco Musumeci10, Giuseppe Santarpino11, Giampiero Esposito12, Francesco Santini13, Paolo Magagna14, Cesare Beghi7, Marco Aiello15, Ester Della Ratta5, Carlo Savini16, Giovanni Troise9, Mauro Cassese17, Theodor Fischlein11, Mattia Glauber18, Giancarlo Passerone13, Giuseppe Punta19, Tatu Juvonen3, Ottavio Alfieri20, Davide Gabbieri21, Domenico Mangino22, Andrea Agostinelli23, Ugolino Livi24, Omar Di Gregorio25, Alessandro Minati26, Mauro Rinaldi4, Gino Gerosa2, Giuseppe Faggian1; The RECORD & ITA investigators
1Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy, 2Division of Cardiac Surgery, University of Padua, 3Division of Cardiac Surgery, University of Oulu, Finland, 4Division of Cardiac Surgery University of Torino, Italy, 5Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Italy, 6Division of Cardiac Surgery Monzino Hospital, Milan, Italy, 7Cardiac Surgery Unit, Insubria University, Italy, 8Clinica Montevergine, Avellino, Italy, 9Cardiac Surgery Unit, Poliambulanza Foundation, Brescia, Italy, 10Department of Cardiac Surgery, San Camillo Hospital, Rome, Italy, 11Cardiovascular Center, Klinikum Nürnberg - Paracelsus Medical University, Nürnberg, Germany, 12Division of Cardiac Surgery, Humanitas Gavazzeni Hospital, Italy, 13IRCCS San Martino University Hospital, Genoa, Italy, 14San Bortolo Hospital, Vicenza, Italy, 15University of Pavia, Italy, 16Policlinico Sant’Orsola Malpighi, Bologna, Italy, 17Division of Cardiac Surgery, Clinica S. Maria, Bari, Italy, 18Fondazione Monasterio, Massa, Italy, 19Ordine Mauriziano Hospital, Torino, Italy, 20San Raffaele University Hospital, Milan, Italy, 21Cardiac Surgery Hesperia Hospital, Modena, Italy, 22Division of Cardiac Surgery, Mestre, Italy, 23Division of Cardiac Surgery, University of Parma, Italy, 24S. Maria della Misericordia Hospital, Udine, Italy, 25Division of Cardiac Surgery, Cuneo, Italy, 26Division of Cardiac Surgery, AOU Trieste, Italy
Background and aim of the study: The study aim was to compare the outcome of transapical transcatheter aortic valve replacement (TaTAVR) and traditional aortic valve replacement (AVR) in redo from two real-world registries.
Methods: The 30-day and follow up outcome of 462 patients enrolled in two multicenter redo registries, treated with redo-AVR (RAVR; n = 292 patients) or TaTAVR (n = 170 patients), were analyzed according to VARC-2 criteria, stratified also by propensity-matching analysis.
Results: TaTAVR-patients were older and sicker than RAVR patients, and reported a higher all-cause 30-day mortality (p <0.01), a higher risk for all-cause mortality (p = 0.006) and cardiovascular mortality (p = 0.05) at follow up, but similar 30-day cardiovascular mortality (p = 0.12). Prolonged intubation (p <0.01) and Acute Kidney Injury Network (AKIN) 2/3 p = 0.02) prevailed in RAVR. TaTAVR patients reported a higher level of major/life-threatening/disabling bleeding (p <0.01) and ‘early safety-events’ (ES) (p = 0.04). Thirty-day acute myocardial infarction (AMI), stroke, and follow up freedom from acute heart
failure (AHF), from stroke and from reinterventions were similar (p = NS). The NYHA class was better after RAVR (p <0.01). The intermediate-to-high risk (Logistic EuroSCORE RAVR 17.1 ± 8.5; TaTAVR 16.0 ± 17.0) propensity-matched population demonstrated comparable 30-day and follow up all-cause and cardiovascular mortality, ES, AMI, stroke, prolonged intubation, follow up freedom from AHF, from stroke and from reinterventions and NYHA class. TaTAVR still reported lower levels of AKIN 2/3 (2.2% versus 15.6%, p = 0.03) and shorter hospitalization (9.5 ± 3.4 days versus 12.0 ± 7.0 days, p = 0.03).
Conclusion: Outcome differences between RAVR and TaTAVR in redo-scenarios reflect methodological differences and different baseline risk profiles. Propensity-matched patients showed a better renal outcome after TaTAVR.
*Drs. Onorati and D’Onofrio contributed equally to this article and should both be considered as first authors
The Journal of Heart Valve Disease 2015;24:669-678
|Aortic Valve Replacement in Redo-Scenarios: A Comparison Between Traditional Aortic Valve Replacement (TAVR) and Transapical-TAVR from Two Real-World Multicenter Registries|
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