Increased Risk of Surgical Aortic Valve Replacement After Prior Transcatheter vs Surgical Aortic Valve Replacement With Concomitant Valve Disease

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic Surgery Pub Date : 2025-10-01 Epub Date: 2025-01-24 DOI:10.1016/j.athoracsur.2025.01.005

Robert B. Hawkins MD, MSc , Barbara C.S. Hamilton MD, MS , Devraj Sukul MD, MSc , G. Michael Deeb MD , Gorav Ailawadi MD, MBA , Shinichi Fukuhara MD

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Abstract

Background

The cause of increased risk for reoperation after transcatheter aortic valve replacement (TAVR) vs prior surgical aortic valve replacement (SAVR) is poorly understood. This study evaluated the impact of concomitant mitral and tricuspid valve disease on associated risk of TAVR explantation.

Methods

Patients undergoing aortic valve replacement after prior SAVR or TAVR were extracted from The Society of Thoracic Surgeons Adult Cardiac Surgery Database (2011-2021). Patients were stratified by TAVR explantation status and presence of severe concomitant valve disease for analyses. Risk adjustment was performed by multivariable logistic regression. Interaction terms were used to evaluate differential risk of concomitant valve disease for TAVR explantation vs redo-SAVR.

Results

Of 24,097 redo aortic valve replacement patients, 877 (3.6%) underwent TAVR explantation. TAVR explantation patients had higher rates of concomitant severe valve disease (17% vs 14%; P < .001). Patients with severe concomitant valve disease had worse operative mortality after TAVR explantation (26.2% vs 14.6%; P < .001) and redo-SAVR (12.3% vs 6.9%; p < .001). TAVR explantation was independently associated with higher mortality (adjusted odds ratio [OR_adj], 1.3 [1.0-1.6]; P = .030). Severe mitral regurgitation (OR_adj, 1.2 [1.0-1.6]; P = .017), mitral stenosis (OR_adj, 2.0 [1.5-2.7; P < .001), and tricuspid regurgitation (OR_adj, 1.6 [1.3-1.9]; P < .001) were all associated with mortality, although these factors were not associated with disproportionately higher risk during TAVR explantation (P > .05).

Conclusions

TAVR explantation cases have a higher burden of severe concomitant valve disease than redo-SAVR cases. Heart teams should consider these findings when discussing initial procedure choices for patients with multivalve disease, given their extreme risk at time of TAVR explantation.

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先前经导管主动脉瓣置换术与合并瓣膜疾病的主动脉瓣置换术相比风险增加。

背景：经导管主动脉瓣置换术（TAVR）与既往手术主动脉瓣置换术（SAVR）后再手术风险增加的病因尚不清楚。本研究评估合并二尖瓣和三尖瓣疾病对TAVR外植体相关风险的影响。方法：从胸外科学会成人心脏外科数据库（2011-2021）中提取先前SAVR或TAVR后接受主动脉瓣置换术的患者。根据TAVR外植体状态和是否存在严重合并瓣膜疾病对患者进行分层分析。采用多变量logistic回归进行风险调整。利用相互作用项来评估TAVR外植体与修复- savr并发瓣膜疾病的差异风险。结果：24,097例重做主动脉瓣置换术患者中，877例（3.6%）接受了TAVR移植。TAVR外植体患者合并严重瓣膜疾病的发生率较高（17% vs 14%, padj 1.3 [1.0-1.6], p=0.030）。重度二尖瓣返流（ORadj 1.2 [1.0 ~ 1.6], p=0.017），二尖瓣狭窄（ORadj 2.0 [1.5 ~ 2.7, padj 1.6 [1.3 ~ 1.9], p= 0.05）。结论：TAVR外植体患者比复发性savr患者有更高的严重合并瓣膜疾病负担。考虑到多瓣膜患者在TAVR移植时的极端风险，心脏团队在讨论多瓣膜疾病患者的初始手术选择时应考虑这些结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.

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