Interventional versus Surgical Treatment of Degenerated Freestyle Prosthesis

Abstract

Background Bioprosthetic stentless aortic valves may degenerate over time and will require replacement. This study aimed to evaluate early- and mid-term outcomes after isolated surgical redo aortic valve replacement (redo-SAVR) and transcatheter valve-in-valve implantation (TAVI-VIV) for degenerated stentless Freestyle bioprostheses.

Methods We reviewed records of 56 patients at a single center. Overall, 37 patients (66.1%) received TAVI-VIV and 19 (33.9%) received redo-SAVR.

Results Thirty-day survival was similar in both groups (100%). One-year survival was comparable between groups (97.3% in TAVI-VIV and 100% in redo-SAVR, p = 1.0). The difference in mid-term survival after adjusting for age and EuroScore II was not significant (p = 0.41). The incidence of pacemaker implantation after TAVI-VIV was higher than after redo-SAVR (19.4% vs. 0%, p = 0.08).

Conclusion The 30-day and 1-year survival rates after both procedures were outstanding, irrespective of baseline characteristics. Isolated redo-SAVR should be favored in young patients, as the pacemaker implantation rate is lower. TAVI-VIV for degenerated Freestyle prosthesis can be a method of choice in elderly patients and those with high operative risk.

Keywords

xenograft - reoperation - heart valve - percutaneous (TAVI) - heart valve surgery - aortic valve and root

Note

This study was presented in part as a poster presentation at the 50th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery (DGTHG), 2021.

Publication History

Received: 25 July 2022

Accepted: 14 January 2023

Article published online:
01 March 2023

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