UH Study Shows National Trends in Reoperative Surgical Aortic Valve Replacement

Findings suggest more patients are being treated with transcatheter valve-in-valve approach

Innovations in Cardiovascular Medicine & Surgery - Winter 2019

A new review of Society of Thoracic Surgeons (STS) data shows how the advent of transcatheter valve-in-valve technology is affecting patients who need treatment for a degenerated aortic valve prosthesis. Results of the analysis were presented as the Richard E. Clark Memorial Paper for Adult Cardiac Surgery at the STS meeting on Jan. 29, 2019.

A group of cardiologists, interventional cardiologists and cardiac surgeons from University Hospitals Cleveland Medical Center, in collaboration with investigators from other institutes, analyzed 4,239 patients nationwide who underwent isolated reoperative surgical aortic valve replacement (SAVR) for a degenerated bioprosthesis from January 2012 through December 2016. Cardiac surgeon Joseph F. Sabik, MD, Chairman of the Department of Surgery at UH Cleveland Medical Center, Surgeon-in-Chief and Vice President for Surgical Operations, University Hospitals; and Professor, Case Western Reserve University School of Medicine led the group.

 Joseph Sabik, MD

“The motivation for the project was to look at trends in reoperative surgical aortic valve replacement,” says Dr. Sabik. “Transcatheter valve-in-valve technology was approved by the FDA in 2015. We wanted to look at how this has influenced the number and risk profile of patients undergoing reoperative SAVR for degenerated bioprosthesis.”

Results show that the number of patients undergoing SAVR for a failed aortic bioprosthesis increased substantially from 2012 to 2014, with a relative change of 7.25 percent. However, this trend partially reversed following FDA approval of transcatheter valve-in-valve technology. In 2015 and 2016, SAVR rates decreased by 3.4 percent.

“The number of patients undergoing reoperative surgical aortic valve replacement for degenerated bioprostheses decreased after the FDA approval,” says Sajjad Raza, MD, Associate Director of the University Hospitals Research in Surgical Outcomes & Effectiveness (RISES) Center and co-lead author of the project. “It implies that some of these patients may have undergone valve-in-valve TAVR.”
The research team also found that SAVR patient characteristics changed over time.

“We observed decreasing ages and decreasing STS-predicted mortality risk-scores for patients undergoing reoperative SAVR from 2012 to 2016,” Dr. Sabik says. “These trends may reflect adoption of valve-in-valve TAVR for older and higher surgical risk patients in the U.S. following its FDA approval in 2015.”

Dr. Sabik and Dr. Raza say they hope these findings will help clinicians choose the best option for their patients.

“SAVR and valve-in-valve TAVR should not be seen as competitive procedures -- they should instead be seen as complementary,” says Dr.Raza. “Depending on patient comorbidities, some patients may have better outcomes after SAVR, while other patients may fare better outcomes with valve-in-valve TAVR.”

“Not much data are available comparing the outcomes of valve-in-valve TAVR with reoperative SAVR,” Dr. Sabik says. “Though the short-term outcomes of the two procedures appear similar in limited data that is available, the long-term durability of valve-in-valve TAVR still needs to be evaluated.”

“Our results show that reoperative SAVR for degenerated bioprosthesis can be performed safely with low operative morbidity and mortality,” says Dr. Sabik. “These results provide a national benchmark against which outcomes of valve-in-valve TAVR can be compared in future studies.”