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Aortic valved homograft degeneration: surgical or transcatheter approach for repeat aortic valve replacement?
- Source :
-
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2024 Jul 01; Vol. 66 (1). - Publication Year :
- 2024
-
Abstract
- Objectives: Aortic valved allografts (homografts) have been used alternatively to mechanical or biological valve prostheses in expectation of better durability; however, homograft valves do degenerate, and redo procedures have proven challenging due to heavy wall calcification. The aim of the study was to compare the outcome of open surgical (SAVR) and transcatheter aortic valve replacement (TAVR) in degenerated homografts.<br />Methods: Between 1993 and 2022, 81 patients underwent repeat aortic valve procedures having previously received an aortic homograft. The redo had become necessary due to regurgitation in 85% and stenosis in 15%. Sixty-five percent underwent open surgery, 35% TAVR.<br />Results: Isolated SAVR was possible in 79%, and root procedures were necessary in 21%. TAVR was performed in 79% via transfemoral and 21% via transapical access. Median prosthetic valve size was 23 (22.3-23.2) mm in the SAVR and 26 (25.2-26.9) in the TAVR group. Thirty-day mortality was 0% in the TAVR and 7% in the SAVR group (P = n.s.). TAVR showed a significantly better outcome concerning prolonged ventilation (0 vs 21%, P = 0.013) as well as ICU (1 vs 2 days; P < 0.001) and in-hospital stay (10.5 vs 13 days; P = 0.028). Five-year survival was statistically comparable between groups, and no severe leakage was observed.<br />Conclusions: SAVR following structural homograft degeneration shows acceptable results, but the perioperative risk remains substantial and poorly predictable. TAVR presents a reasonable and more easily accessible alternative and is associated with good short- and mid-term results. In the absence of relevant contraindications, TAVR is presently the preferred treatment option for these patients at our center.<br /> (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Subjects :
- Humans
Male
Female
Aged
Aged, 80 and over
Aortic Valve Stenosis surgery
Allografts
Heart Valve Prosthesis Implantation methods
Heart Valve Prosthesis Implantation statistics & numerical data
Prosthesis Failure
Treatment Outcome
Retrospective Studies
Bioprosthesis
Middle Aged
Aortic Valve surgery
Transcatheter Aortic Valve Replacement methods
Reoperation statistics & numerical data
Heart Valve Prosthesis
Subjects
Details
- Language :
- English
- ISSN :
- 1873-734X
- Volume :
- 66
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 39037934
- Full Text :
- https://doi.org/10.1093/ejcts/ezae280