Bioprosthetic valve fracture for valve-in-valve transcatheter aortic valve implantation in patients with structural valve degeneration: Systematic review with meta-analysis

S. Michel Pompeu, Sérgio C. Rayol, Jef Van den Eynde, Luiz Rafael P. Cavalcanti, Antonio C. Escorel Neto, Álvaro M. Perazzo, Alexander Weymann, Arjang Ruhparwar, Gianluca Torregrossa, Serge Sicouri, Basel Ramlawi

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations

Abstract

Objectives: To determine the outcomes of bioprosthetic valve fracture (BVF) in valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) for patients with structural valve degeneration (SVD) of bioprosthetic surgical valves (BSV) implanted during surgical aortic valve replacement (SAVR). Methods: A systematic review was conducted including studies published by May 2021. The primary endpoints of the study were 30-day mortality, annular rupture, stroke, paravalvular leak, pacemaker implantation, and coronary obstruction. The secondary endpoints were mean valve gradients (mmHg) and aortic valve area (AVA—cm2). A meta-analysis was conducted using the software R, version 3.6.3 (R Foundation for Statistical Computing). Results: Four studies including 242 patients met our eligibility criteria. The overall proportions for 30-day mortality, annular rupture, stroke, paravalvular leak, pacemaker implantation and coronary obstruction were 2.1%, <1.0%, <1.5%, <1.0%, <1.0%, and <1.5%, respectively. After ViV-TAVI with BVF, the difference in means for mean valve gradients showed a significant reduction (random-effects model: −26.7; −28.8 to −24.7; p <.001), whereas the difference in means for AVA showed a significant increase (random-effects model: 0.55 cm2; 0.13–0.97; p =.029). Despite the improvement in AVA means, these remain too low after the procedure highly likely due to the small size of the bioprosthetic valves implanted during the index SAVR. Conclusion: ViV-TAVI with BVF has proven to be a promising option but data are still too scarce to enable us to draw definitive conclusions. Despite the decrease in gradients, postprocedural AVA remains worrisome. Studies with better designs and larger sample sizes are needed to advance this treatment option.

Original languageEnglish
Pages (from-to)4722-4731
Number of pages10
JournalJournal of Cardiac Surgery
Volume36
Issue number12
DOIs
StatePublished - Dec 2021
Externally publishedYes

Keywords

  • aortic valve
  • cardiac surgical procedures
  • cardiovascular surgical procedures
  • heart valve prosthesis implantation
  • meta-analysis
  • transcatheter aortic valve replacement

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