Early survival data favor valve-in-valve TAVR over redo SAVR—long-term data flip the script
Valve-in-valve transcatheter aortic valve replacement (TAVR) is associated with a higher short-term survival rate than redo surgical aortic valve replacement (SAVR) when patients present with a failing surgical aortic bioprosthetic valve, according to a new meta-analysis published in the American Journal of Cardiology.[1] However, long-term outcomes data appear to favor redo SAVR.
“Lifetime management in a population with a longer life expectancy has become part of our conversations with patients more frequently and there is a growing interest in knowing how these patients fare in the long run,” wrote first author Michel Pompeu Sá MD, MSc, PhD, with the department of cardiothoracic surgery at the University of Pittsburgh, and colleagues.
The group examined data from 16 different studies for its meta-analysis, tracking a total of nearly 4,400 patients who presented with failed aortic bioprostheses. While 2,204 patients underwent valve-in-valve TAVR, another 2,169 patients underwent redo SAVR.
Overall, valve-in-valve TAVR was associated with a significantly lower risk of all-cause mortality after six months. After six months, however, things changed; valve-in-valve TAVR was associated with a higher risk of all-cause mortality from that point on.
Another key takeaway was that, according to the team’s meta-regression analysis, implanting valves smaller than 25 mm in size was linked to a higher risk of all-cause death among valve-in-valve TAVR patients.
“This points to the importance of implanting valves which will offer the best effective orifice area possible,” the authors wrote.
The researchers did note that their findings included a certain risk of bias due to the differences between the two patient groups. For instance, valve-in-valve TAVR patients were more likely to present with a history of undergoing coronary artery bypass graft surgery, which is known to increase the risk of all-cause mortality. Additional research is recommended to take a closer look at the similarities and differences between these two treatment options.
“Since these results are pooled data from observational studies, they should be interpreted with caution and trials are warranted,” the group concluded.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.