Redo Aortic Valve Replacement After Prior Transcatheter versus Surgical Aortic Valve Replacement: Insights from Western Experience
Introduction: The demand for reoperation on the aortic valve in Albania is rising, mirroring the increasing average age of the population and the subsequent rise in patients requiring aortic valve surgery. This trend underscores the need for this informative article, which aims to provide insights i...
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| Format: | Article |
| Language: | English |
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Albanian Society for Trauma and Emergency Surgery
2025-01-01
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| Series: | Albanian Journal of Trauma and Emergency Surgery |
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| Online Access: | http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/440 |
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| author | Arber Aliu Klodiana Durici Ira Lazo Altin Veshti |
| author_facet | Arber Aliu Klodiana Durici Ira Lazo Altin Veshti |
| author_sort | Arber Aliu |
| collection | DOAJ |
| description | Introduction: The demand for reoperation on the aortic valve in Albania is rising, mirroring the increasing average age of the population and the subsequent rise in patients requiring aortic valve surgery. This trend underscores the need for this informative article, which aims to provide insights into the risks and outcomes of aortic valve reoperations, particularly in light of efforts by interventional cardiologists to expand the indications for TAVR to younger and lower-risk patients. Data from the Society of Thoracic Surgeons (STS) National Database reveal results that warrant attention, with concerns over reoperations after TAVR growing, mainly due to the uncertain feasibility of repeat TAVR.
This article presents a novel perspective on the risks associated with surgical aortic valve replacement (SAVR) after prior TAVR or SAVR. It underscores the urgent need to develop an optimal strategy for managing these patients and offers fresh insight.
Material and Methods: Our research, based on a comprehensive analysis of data from the Society of Thoracic Surgeons in the USA's 10-year database, included individuals who underwent bioprosthetic SAVR following prior TAVR and/or SAVR. Our analyses, which included total and isolated SAVR groups, focused on the primary outcome of operative mortality, ensuring the reliability and thoroughness of our study.
Results: The study included 31,106 patients who underwent SAVR. Among them, 1,126 had prior TAVR (TAVR-SAVR), 674 had undergone SAVR followed by TAVR and SAVR (SAVR-TAVR-SAVR), and 29,306 had undergone prior SAVR (SAVR-SAVR). Matched analysis for isolated SAVR cases showed a 1.74-fold higher operative mortality for TAVR-SAVR than SAVR-SAVR (P = 0.020). In our center, 5 cases have been performed in the last two years with excellent results, no losses, and operating times close to the first-time interventions.
Conclusions: This study's findings significantly contribute to the field. They could influence clinical practice, particularly for patients with longer life expectancies and anatomy unsuitable for TAVR. They suggest an initial SAVR approach may provide better results even in necessary surgical re-interventions on the aortic valve.
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| format | Article |
| id | doaj-art-b827b48d77554ec392f5e98922d517cf |
| institution | Kabale University |
| issn | 2521-8778 2616-4922 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Albanian Society for Trauma and Emergency Surgery |
| record_format | Article |
| series | Albanian Journal of Trauma and Emergency Surgery |
| spelling | doaj-art-b827b48d77554ec392f5e98922d517cf2025-01-19T14:24:38ZengAlbanian Society for Trauma and Emergency SurgeryAlbanian Journal of Trauma and Emergency Surgery2521-87782616-49222025-01-019110.32391/ajtes.v9i1.440Redo Aortic Valve Replacement After Prior Transcatheter versus Surgical Aortic Valve Replacement: Insights from Western ExperienceArber Aliu0Klodiana Durici1Ira Lazo2Altin Veshti3Department of Cardiac Surgery, Mother Teresa University Hospital Center, Tirana, ALBANIAService of Cardiac Surgery, University Hospital Center” Mother Theresa”, Tirana, AlbaniaService of Cardiac Surgery, University Hospital Center” Mother Theresa”, Tirana, AlbaniaService of Cardiac Surgery, University Hospital Center” Mother Theresa”, Tirana, AlbaniaIntroduction: The demand for reoperation on the aortic valve in Albania is rising, mirroring the increasing average age of the population and the subsequent rise in patients requiring aortic valve surgery. This trend underscores the need for this informative article, which aims to provide insights into the risks and outcomes of aortic valve reoperations, particularly in light of efforts by interventional cardiologists to expand the indications for TAVR to younger and lower-risk patients. Data from the Society of Thoracic Surgeons (STS) National Database reveal results that warrant attention, with concerns over reoperations after TAVR growing, mainly due to the uncertain feasibility of repeat TAVR. This article presents a novel perspective on the risks associated with surgical aortic valve replacement (SAVR) after prior TAVR or SAVR. It underscores the urgent need to develop an optimal strategy for managing these patients and offers fresh insight. Material and Methods: Our research, based on a comprehensive analysis of data from the Society of Thoracic Surgeons in the USA's 10-year database, included individuals who underwent bioprosthetic SAVR following prior TAVR and/or SAVR. Our analyses, which included total and isolated SAVR groups, focused on the primary outcome of operative mortality, ensuring the reliability and thoroughness of our study. Results: The study included 31,106 patients who underwent SAVR. Among them, 1,126 had prior TAVR (TAVR-SAVR), 674 had undergone SAVR followed by TAVR and SAVR (SAVR-TAVR-SAVR), and 29,306 had undergone prior SAVR (SAVR-SAVR). Matched analysis for isolated SAVR cases showed a 1.74-fold higher operative mortality for TAVR-SAVR than SAVR-SAVR (P = 0.020). In our center, 5 cases have been performed in the last two years with excellent results, no losses, and operating times close to the first-time interventions. Conclusions: This study's findings significantly contribute to the field. They could influence clinical practice, particularly for patients with longer life expectancies and anatomy unsuitable for TAVR. They suggest an initial SAVR approach may provide better results even in necessary surgical re-interventions on the aortic valve. http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/440TAVRSAVRAortic Valve Reoperation |
| spellingShingle | Arber Aliu Klodiana Durici Ira Lazo Altin Veshti Redo Aortic Valve Replacement After Prior Transcatheter versus Surgical Aortic Valve Replacement: Insights from Western Experience Albanian Journal of Trauma and Emergency Surgery TAVR SAVR Aortic Valve Reoperation |
| title | Redo Aortic Valve Replacement After Prior Transcatheter versus Surgical Aortic Valve Replacement: Insights from Western Experience |
| title_full | Redo Aortic Valve Replacement After Prior Transcatheter versus Surgical Aortic Valve Replacement: Insights from Western Experience |
| title_fullStr | Redo Aortic Valve Replacement After Prior Transcatheter versus Surgical Aortic Valve Replacement: Insights from Western Experience |
| title_full_unstemmed | Redo Aortic Valve Replacement After Prior Transcatheter versus Surgical Aortic Valve Replacement: Insights from Western Experience |
| title_short | Redo Aortic Valve Replacement After Prior Transcatheter versus Surgical Aortic Valve Replacement: Insights from Western Experience |
| title_sort | redo aortic valve replacement after prior transcatheter versus surgical aortic valve replacement insights from western experience |
| topic | TAVR SAVR Aortic Valve Reoperation |
| url | http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/440 |
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