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Acute Myocardial Infarction and Stroke as Complications in Valve in Valve Transcatheter Aortic Valve Implantation Versus Redo Surgical Aortic Valve Replacement for Degenerated Bioprosthetic Valves


Abstract

Introduction: Redo-Surgical Aortic Valve Replacement (redo-SAVR) is the gold standard treatment for replacing degenerated Bioprosthetic Valves (BPV). Recently, Valve in Valve-Transcatheter Aortic Valve Implantation (ViV-TAVI) has emerged as a less invasive alternative of redo-SAVR in high-risk patients. However, it’s efficacy is yet unclear and is to be explored further for wider adoption. 

 

Methods: We conducted a systematic search of meta-analysis studies comparing the safety and efficacy of ViV-TAVI versus redo-SAVR using the PubMed search engine from inception to May 2021 following the PRISMA guidelines. A meta-meta-analysis was performed by obtaining a pooled odds ratio, 95% confidence interval (95% CI) using a random effects model. I2 values of 25%, 50%, and 75% represented low, medium, and high heterogeneity.  

 

Results: Out of 20 meta-analysis screened, we have finally included 9 meta-analysis studies which reported comparison of complications of acute myocardial infarction (MI) and stroke in both the procedures. We found that there was no significant difference between Valve in Valve-Transcatheter Aortic Valve Implantation and Redo-Surgical Aortic Valve Replacement in regards to acute myocardial infarction complication (pooled OR:1.15; 95%CI:0.84-1.59; p=0.38) with 0% heterogeneity (p=0.80; I2:0%). However, Valve in Valve-Transcatheter Aortic Valve Implantation had less risk of having a stroke complication (pooled OR:0.71; 95%CI:0.59-0.84; p<0.0001) with no heterogeneity (p=0.97; I2:0%) compared to Redo-Surgical Aortic Valve Replacement. 

 

Conclusion: ViV-TAVI is associated with significantly lower risk of having stroke compared to redo-SAVR. But we did not find any significant difference between both groups in having acute MI complication risk. Hence, our study supports that ViV-TAVI might be a safer and feasible alternative to redo-SAVR for replacement of failed BPV in high risk patients.

Poster
non-peer-reviewed

Acute Myocardial Infarction and Stroke as Complications in Valve in Valve Transcatheter Aortic Valve Implantation Versus Redo Surgical Aortic Valve Replacement for Degenerated Bioprosthetic Valves


Author Information

Shubhi Jain Corresponding Author

Department of Internal Medicine, Gujarat Medical Education and Research Society Medical College, Gotri, Vadodara, IND

Nawal Ali

Department of Internal Medicine, Liaquat University of Medical Health and Science, Heyderbad, PAK

Nida Khan

Department of Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK

Abbas Altamimi

Emergency medicine, Amiri hospital, Kuwait , KWT

Karanrajsinh Raol

Department of Internal Medicine, G.M.E.R.S. Medical College and General Hospital, Gandhinagar, IND

Sowmya Madireddy

Internal Medicine, Mamata Medical College, Khammam, IND

Jigisha H. Rakholiya

Internal Medicine, Mayo Clinic, Rochester, USA

Abdur Raheem

Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, USA

Rizwan Rabbani

Nephrology, Temple University Hospital, Philadelphia, USA

Surya Aedma

Internal Medicine, Carle Foundation Hospital, Urbana, USA

Suveenkrishna Pothuru

Internal Medicine, Ascension Via Christi Hospital, Manhattan, USA


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