Redo surgical aortic valve replacement: An outdated technique in the era of valve-in-valve procedures? - 04/09/25
, Roman Stiefel a, 1, Sumi Westhofen a, Eik Vettorazzi b, Till Demal a, Beate Reiter a, Björn Sill a, Lenard Conradi a, Yousuf Al Assar a, Hermann Reichenspurner a, c, Christian Detter aGraphical abstract |
Highlights |
• | Re-SAVR without endocarditis results in very low in-hospital death rates. |
• | Re-SAVR should guide heart-team decision-making for failed bioprostheses. |
Abstract |
Background |
The treatment of degenerative prosthetic aortic valves is increasingly important. However, redo surgical aortic valve replacement (Re-SAVR) carries higher perioperative risks than primary surgical aortic valve replacement.
Aim |
This study aims to identify predictors of early morbidity and death after Re-SAVR.
Methods |
A retrospective analysis of 220 patients scheduled for elective Re-SAVR between 2009 and 2017 was conducted. Patients were divided into isolated (n=87) and combined (n=133) redo procedures. The primary endpoint was in-hospital death, and secondary endpoints were postoperative complications, such as stroke, dialysis and pacemaker implantation. Regression analysis identified independent predictors of death.
Results |
Among the patients undergoing Re-SAVR (mean age, 62.6±13.2years; 71% male; mean EuroSCORE II, 12.6±11.1%), 86.4% received biological prostheses and 13.6% received mechanical prostheses. The in-hospital death rate was 5.7% for isolated Re-SAVR and 18.0% for combined procedures (P=0.003). Excluding patients with endocarditis, the in-hospital death rate was 0% for isolated Re-SAVR and 19.7% for combined procedures (P=0.002). The incidence of postoperative complications after an isolated procedure was similar to that after a combined procedure. Independent predictors of 30-day death were previous coronary artery bypass grafting (odds ratio: 14.12, 95% confidence interval: 4.40–51.35; P<0.001), a combined procedure (odds ratio: 7.01, 95% confidence interval: 2.09–31.54; P=0.004) and New York Heart Association functional class III/IV (odds ratio: 3.73, 95% confidence interval: 1.31–12.58; P=0.020).
Conclusions |
The perioperative risk of death after isolated Re-SAVR in patients without endocarditis was 0%. Independent predictors of in-hospital death included previous coronary artery bypass grafting, combined procedures and New York Heart Association class III/IV. These findings may inform the decision-making process of the heart team regarding the optimal approach (surgical or transcatheter) for redo aortic valve replacement.
Le texte complet de cet article est disponible en PDF.Keywords : Redo surgery, Aortic valve surgery, Valve-in-valve procedure
Plan
Vol 118 - N° 8-9
P. 429-435 - septembre 2025 Retour au numéro
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