Conventional redo biological valve replacement over 20 years: Surgical benchmarks should guide patient selection for transcatheter valve-in-valve therapy

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Conventional redo biological valve replacement over 20 years: Surgical benchmarks should guide patient selection for transcatheter valve-in-valve therapy John M. Stulak, MD, Vakhtang Tchantchaleishvili, MD, Richard C. Daly, MD, Mackram F. Eleid, MD, Kevin L. Greason, MD, Joseph A. Dearani, MD, Lyle D. Joyce, MD, PhD, Alberto Pochettino, MD, Hartzell V. Schaff, MD, Simon Maltais, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 156, Issue 4, Pages 1380-1390.e1 (October 2018) DOI: 10.1016/j.jtcvs.2018.03.176 Copyright © 2018 Terms and Conditions

Figure 1 Late survival for all patients undergoing conventional redo biological valve replacement. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1380-1390.e1DOI: (10.1016/j.jtcvs.2018.03.176) Copyright © 2018 Terms and Conditions

Figure 2 For patients who were deceased at last follow-up, 2-dimensional scatter plots demonstrate varying length of postoperative survival. AVR, Aortic valve replacement; MVR, mitral valve replacement. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1380-1390.e1DOI: (10.1016/j.jtcvs.2018.03.176) Copyright © 2018 Terms and Conditions

Figure 3 For the entire cohort, late survival for patients with preoperative New York Heart Association (NYHA) functional class III or IV and prior coronary artery bypass grafting (prCABG) is shown compared with patients without this preoperative combination of clinical risk factors. Patients with previous (prev) CABG and preoperative NYHA functional class III or IV had significantly lower survival compared with patients without this preoperative combination of clinical risk factors. CABG, Coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1380-1390.e1DOI: (10.1016/j.jtcvs.2018.03.176) Copyright © 2018 Terms and Conditions

Figure 4 For the redo aortic valve (AV) cohort, late survival for patients with preoperative New York Heart Association (NYHA) functional class III or IV and prior coronary artery bypass grafting (prCABG) is shown compared with patients without this preoperative combination of clinical risk factors. Patients with previous CABG and preoperative NYHA functional class III or IV had significantly lower survival compared with patients without this preoperative combination of clinical risk factors. CABG, Coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1380-1390.e1DOI: (10.1016/j.jtcvs.2018.03.176) Copyright © 2018 Terms and Conditions

Figure 5 For the redo mitral valve (MV) cohort, late survival for patients with preoperative New York Heart Association (NYHA) functional class III or IV and prior coronary artery bypass grafting (prCABG) is shown compared with patients without this preoperative combination of clinical risk factors. Patients with previous CABG and preoperative NYHA functional class III or IV had significantly lower survival compared with patients without this preoperative combination of clinical risk factors. CABG, Coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1380-1390.e1DOI: (10.1016/j.jtcvs.2018.03.176) Copyright © 2018 Terms and Conditions

Figure 6 Survival according to era of surgery is presented. There is a significant difference between survival for patients having surgery during 1990s compared with more contemporary era (P < .01). The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1380-1390.e1DOI: (10.1016/j.jtcvs.2018.03.176) Copyright © 2018 Terms and Conditions

Figure 7 Receiver operating characteristic analysis to assess the discriminatory power of the Society of Thoracic Surgeons predicted risk of mortality is shown for the redo aortic valve (AV) cohort. AUC, Area under the curve. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1380-1390.e1DOI: (10.1016/j.jtcvs.2018.03.176) Copyright © 2018 Terms and Conditions

Figure 8 Receiver operating characteristic analysis to assess the discriminatory power of the Society of Thoracic Surgeons predicted risk of mortality is shown for the redo mitral valve (MV) cohort. AUC, Area under the curve. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1380-1390.e1DOI: (10.1016/j.jtcvs.2018.03.176) Copyright © 2018 Terms and Conditions

Patients with previous CABG and NYHA functional class III or IV had significantly lower survival. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1380-1390.e1DOI: (10.1016/j.jtcvs.2018.03.176) Copyright © 2018 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1380-1390 The Journal of Thoracic and Cardiovascular Surgery 2018 156, 1380-1390.e1DOI: (10.1016/j.jtcvs.2018.03.176) Copyright © 2018 Terms and Conditions