B748 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 74, NO.
13, SUPPL B, 2019
TCT-763
Valve in Valve Transcatheter Aortic Valve Replacement
Versus Redo Surgical Aortic Valve Replacement: Real
World Outcomes From the National Inpatient Sample
(2013–2016)
Grant Kim,1 Arnar Geirsson,2 Michael Cleman,1 John Forrest,2
Ryan Kaple1
1
Yale School of Medicine, New Haven, Connecticut; 2Yale
University, New Haven, Connecticut
BACKGROUND A few small observational studies have eval-
uated the outcome of valve-in-valve (ViV) transcatheter
aortic valve replacement (TAVR) versus redo surgical aortic
valve replacement (SAVR) for failed bioprosthetic aortic
valves. Our aim was to compare in-hospital outcomes for ViV
TAVR versus redo SAVR.
METHODS Adult patients (
18 years of age) with degenera-
tive bioprosthetic valves were abstracted from National
Inpatient Sample using ICD-9-CM and ICD-10-CM and ICD-9-
PCS and ICD-10-PCS codes between 2013 and 2016. Patient
characteristics and hospital events were abstracted. The pri-
mary outcome was in-hospital mortality, pacemaker inser-
tion, and stroke. Sensitivity analysis was performed to
account for change in ICD codes between ICD-9 and ICD-10 in
the fourth quarter of 2015.
RESULTS Between January 2013 and December 2016, 8,195
patients underwent TAVR (n ¼ 2,415) or SAVR (n ¼ 5,780) for
degenerative bioprosthetic aortic valve. Patients who un-
derwent ViV TAVR were older (75.8 years vs. 62.8 years; p <
0.01). Hyperlipidemia, diabetes, chronic kidney disease, cor-
onary artery disease, and heart failure were more common in
patients undergoing ViV TAVR (p < 0.05). Yet ViV TAVR was
associated with less in-hospital mortality (odds ratio [OR]:
0.45; 95% confidence interval [CI]: 0.24 to 0.84) and pace-
maker insertion (OR: 0.37; 95% CI: 0.23 to 0.59) compared
with redo SAVR. Risk for stroke was similar between groups
(OR: 0.91; 95% CI: 0.64 to 1.29). Sensitivity analysis showed
statistically equivalent findings. Cases from 2015 and 2016
showed even greater reduction in in-hospital mortality for
ViV TAVR (OR: 0.28; 95% CI: 0.12 to 0.68) versus redo SAVR.
CONCLUSION In this real-world, nationally representative
observational cohort, ViV TAVR appears to be safe compared
with redo SAVR. The risk for in-hospital mortality and pace-
maker insertion was statistically lower with ViV TAVR
compared with redo SAVR.
CATEGORIES STRUCTURAL: Valvular Disease: Aortic