title: Aortic Valve Replacement in Redo-Scenarios: A Comparison Between Traditional Aortic Valve Replacement (TAVR) and Transapical-TAVR from Two Real-World Multicenter Registries.
abstract: BACKGROUND
  The study aim was to compare the outcome of transapical transcatheter aortic valve replacement (TaTAVR) and traditional aortic valve replacement (AVR) in redo from two real-world registries.
  
  
  METHODS
  The 30-day and follow up outcome of 462 patients enrolled in two multicenter redo registries, treated with redo-AVR (RAVR; n = 292 patients) or TaTAVR (n = 170 patients), were analyzed according to VARC-2 criteria, stratified also by propensity-matching analysis.
  
  
  RESULTS
  TaTAVR-patients were older and sicker than RAVR patients, and reported a higher all-cause 30-day mortality (p <0.01), a higher risk for all-cause mortality (p = 0.006) and cardiovascular mortality (p = 0.05) at follow up, but similar 30-day cardiovascular mortality (p = 0.12). Prolonged intubation (p <0.01) and Acute Kidney Injury Network (AKIN) 2/3 p = 0.02) prevailed in RAVR. TaTAVR patients reported a higher level of major/life-threatening/disabling bleeding (p <0.01) and 'early safety-events' (ES) (p = 0.04). Thirty-day acute myocardial infarction (AMI), stroke, and follow up freedom from acute heart failure (AHF), from stroke and from reinterventions were similar (p = NS). The NYHA class was better after RAVR (p <0.01). The intermediate-to-high risk (Logistic EuroSCORE RAVR 17.1 ± 8.5; TaTAVR 16.0 ± 17.0) propensity-matched population demonstrated comparable 30-day and follow up all-cause and cardiovascular mortality, ES, AMI, stroke, prolonged intubation, follow up freedom from AHF, from stroke and from reinterventions and NYHA class. TaTAVR still reported lower levels of AKIN 2/3 (2.2% versus 15.6%, p = 0.03) and shorter hospitalization (9.5 ± 3.4 days versus 12.0 ± 7.0 days, p = 0.03).
  
  
  CONCLUSIONS
  Outcome differences between RAVR and TaTAVR in redo-scenarios reflect methodological differences and different baseline risk profiles. Propensity-matched patients showed a better renal outcome after TaTAVR. *Drs. Onorati and D'Onofrio contributed equally to this article and should both be considered as first authors.
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.affiliation: Division of Cardiac Surgery, University of Padua.
authors.forename: Augusto
authors.initials: A
authors.lastname: D'Onofrio
authors.affiliation: Division of Cardiac Surgery, University of Oulu, Finland.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.affiliation: Division of Cardiac Surgery University of Torino, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Salizzoni
authors.affiliation: Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Italy.
authors.forename: Marisa
authors.initials: M
authors.lastname: De Feo
authors.affiliation: Division of Cardiac Surgery Monzino Hospital, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Agrifoglio
authors.affiliation: Cardiac Surgery Unit, Insubria University, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
authors.affiliation: Clinica Montevergine, Avellino, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Lucchetti
authors.affiliation: Cardiac Surgery Unit, Poliambulanza Foundation, Brescia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Messina
authors.affiliation: Department of Cardiac Surgery, San Camillo Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Musumeci
authors.affiliation: Cardiovascular Center, Klinikum Nürnberg - Paracelsus Medical University, Nürnberg, Germany.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santarpino
authors.affiliation: Division of Cardiac Surgery, Humanitas Gavazzeni Hospital, Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Esposito
authors.affiliation: IRCCS San Martino University Hospital, Genoa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
authors.affiliation: San Bortolo Hospital, Vicenza, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Magagna
authors.affiliation: Cardiac Surgery Unit, Insubria University, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Beghi
authors.affiliation: University of Pavia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Aiello
authors.affiliation: Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Italy.
authors.forename: Ester
authors.initials: E
authors.lastname: Della Ratta
authors.affiliation: Policlinico Sant'Orsola Malpighi, Bologna, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Savini
authors.affiliation: Cardiac Surgery Unit, Poliambulanza Foundation, Brescia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Troise
authors.affiliation: Division of Cardiac Surgery, Clinica S. Maria, Bari, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Cassese
authors.affiliation: Cardiovascular Center, Klinikum Nürnberg - Paracelsus Medical University, Nürnberg, Germany.
authors.forename: Theodor
authors.initials: T
authors.lastname: Fischlein
authors.affiliation: Fondazione Monasterio, Massa, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
authors.affiliation: IRCCS San Martino University Hospital, Genoa, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Passerone
authors.affiliation: Ordine Mauriziano Hospital, Torino, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Punta
authors.affiliation: Division of Cardiac Surgery, University of Oulu, Finland.
authors.forename: Tatu
authors.initials: T
authors.lastname: Juvonen
authors.affiliation: San Raffaele University Hospital, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.affiliation: Cardiac Surgery Hesperia Hospital, Modena, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Gabbieri
authors.affiliation: Division of Cardiac Surgery, Mestre, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Mangino
authors.affiliation: Division of Cardiac Surgery, University of Parma, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Agostinelli
authors.affiliation: S. Maria della Misericordia Hospital, Udine, Italy.
authors.forename: Ugolino
authors.initials: U
authors.lastname: Livi
authors.affiliation: Division of Cardiac Surgery, Cuneo, Italy.
authors.forename: Omar
authors.initials: O
authors.lastname: Di Gregorio
authors.affiliation: Division of Cardiac Surgery, AOU Trieste, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Minati
authors.affiliation: Division of Cardiac Surgery University of Torino, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.affiliation: Division of Cardiac Surgery, University of Padua.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian The Record Ita Investigators