Valve-in-valve TAVI outperforms repeat SAVR for in-hospital mortality

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Study author Monil Majmundar

Valve-in-valve transcatheter aortic valve implantation (TAVI) was associated with lower in-hospital mortality, but higher 30-day and six-month all-cause readmission than repeat surgical aortic valve replacements (SAVR) in patients with a failed aortic bioprosthetic valve.

This is according to the findings of a retrospective cohort study, published in the February issue of EuroIntervention, in which Monil Majmundar (Maimonides Medical Center, New York, USA) and colleagues compared valve-in-valve TAVI and repeat SAVR using data from 2016 to 2018 taken from the Nationwide Readmission Database.

The study’s primary outcomes were all-cause readmission at both 30 days and six months and in-hospital death. Secondary outcomes included in-hospital stroke, pacemaker implantation, 30-day or six-month major adverse cardiac events (MACE), and mortality during readmission.

The study report that, out of 6,769 procedures recorded during the study period, 3,724 (55%) patients underwent valve-in-valve TAVI, and 3,045 (45%) underwent repeat SAVR. Valve-in-valve TAVI was associated with lower in-hospital all-cause mortality (odds ratio [OR] 0.42, 95% confidence interval [CI]: 0.20–0.90, p=0.026) and a higher rate of 30-day (hazard ratio [HR] 1.46, 95% CI: 1.13–1.90, p=0.004) and 6-month all-cause readmission (HR 1.54, 95% CI: 1.14–2.10, p=0.006) compared with repeat SAVR. All secondary outcomes were comparable between the two groups.

The results led the study team to conclude that valve-in-valve TAVI is associated with lower in-hospital mortality, but higher 30-day and six-month all-cause readmission. However, they add that there was no difference between the two procedures in the risk of in-hospital stroke, post-procedure pacemaker implantation, MACE and mortality during 30-day and six-month readmission compared with repeat SAVR.

These findings, the authors suggest, indicate that valve-in-valve TAVI “can be performed safely in carefully selected patients”.


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