Bi-National Outcomes of Redo Surgical Aortic Valve Replacement in the Era of Valve-in-Valve Transcatheter Aortic Valve

• Published in: Heart, lung & circulation lung & circulation, 2024-10, Vol.33 (10), p.1432-1438
• Main Authors: Flynn, Campbell D., Tran, Lavinia, Reid, Christopher M., Almeida, Aubrey, Marasco, Silvana F.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Valve - surgery; Aortic valve replacement; Aortic Valve Stenosis - surgery; Australia - epidemiology; Bioprosthesis; Female; Follow-Up Studies; Heart Valve Prosthesis; Humans; Long-term outcomes; Male; New Zealand - epidemiology; Prosthesis Failure; Re-operation; Redo AVR; Registries; Reoperation - statistics & numerical data; Retrospective Studies; Risk Factors; Survival Rate - trends; Time Factors; Transcatheter Aortic Valve Replacement - methods; Treatment Outcome
• ISSN: 1443-9506; 1444-2892; 1444-2892
• DOI: 10.1016/j.hlc.2024.06.1032

Implantation of bioprosthetic valves is more common as the population ages and there is a shift towards implanting bioprosthetic aortic valves in an increasingly younger surgical population. Bioprosthetic heart valve insertion, however, carries the long-term risk of valve failure through structural valve degeneration. Re-operative surgical aortic valve replacement has historically been the only definitive management option for patients with prosthetic valve dysfunction, however, data on the short- and long-term outcomes following re-operative surgery in Australia and New Zealand is limited. Data on all patients who underwent redo aortic valve surgery, over a 20-year period (up to 2021) was obtained from the Australian and New Zealand Society of Cardiothoracic Surgery Registry. A total of 1,199 patients (770 males; 64.2% and 429 females; 35.8%) were included in the overall analysis. The 30-day mortality was 6.4% with operative urgency status the most important risk factor for peri-operative mortality. The long-term survival rate of 1,145 patients was 90.5% (95% confidence interval [CI] 88.8%–92.3%), 77% (95% CI 73.9%–80.2%) and 57.2% (95% CI 55.2%–62.8%) at 1-, 5- and 10-years post-procedure, respectively, with a median survival of 12.7 years. Pre-existing chronic kidney disease was strongly associated with poorer long-term survival. For patients under 70 years of age the 1-, 5- and 10-year survival rates were 92.9% (95% CI 90.9%–95.1%), 83.6% (95% CI 80.1%–87.3%) and 73.1% (95% CI 67.4%–79.3%), respectively. The results from this registry study indicate that in Australia and New Zealand, a repeat surgical aortic valve replacement can result in a relatively low mortality rate, serving as a reference point for medical procedures in these regions.