What does this research mean for the field?

ViV-TAVI results in a greater mean aortic valve gradient of 0.72 mmHg and a 2.89 times higher risk of paravalvular leak compared to reSAVR. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The analysis aims to compare valve hemodynamics of ViV-TAVI against reSAVR in patients with failing bioprosthetic aortic valves.

February 6, 2026

Hemodynamic comparison of valve in valve transcatheter versus redo surgical replacement of a failing bioprosthetic aortic valve: an updated meta-analysis of echocardiographic data

Key Result

ViV-TAVI showed higher mean aortic valve gradient by 0.72 mmHg, 2.89-fold increased paravalvular leak risk, and up to 1.68-fold higher patient-prosthesis mismatch risk vs reSAVR.

Key Points

The analysis aims to compare valve hemodynamics of ViV-TAVI against reSAVR in patients with failing bioprosthetic aortic valves.
Conducted a systematic search in PubMed, Web of Science, and Scopus until June 2023.
Included 26 studies meeting the prespecified criteria for meta-analysis based on PRISMA guidelines.
Performed a random effect meta-analysis on echocardiographic data.
ViV-TAVI showed greater mean aortic valve gradient compared to reSAVR (mean difference: 0.72).
Increased risk of paravalvular leak after ViV-TAVI (Relative Risk: 2.89).
Higher incidence of patient-prosthesis mismatch (PPM) seen in ViV-TAVI, with RR: 1.68 for any PPM and RR: 1.62 for severe PPM.

Structured PICO

Does ViV-TAVI improve post-procedural valve hemodynamics compared to reSAVR in patients with a degenerated bioprosthetic aortic valve?

Population

17,581 patients with a degenerated, surgically implanted, bioprosthetic aortic valve across 26 studies

Intervention

Valve in Valve Transcatheter Aortic Valve Implantation (ViV-TAVI)

Comparator

Redo surgical aortic valve replacement (reSAVR)

Outcome

Post-procedural echocardiographic parameters assessing valve hemodynamics (mean aortic valve gradient)surrogate

ViV-TAVI results in suboptimal valve hemodynamics, including higher gradients, more paravalvular leak, and increased severe patient-prosthesis mismatch, compared to redo surgical aortic valve replacement.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Valve in Valve Transcatheter Aortic Valve Implantation (ViV-TAVI) has recently emerged as a safe and efficient alternative to repeat surgery (reSAVR) for patients with a degenerated, surgically implanted, bioprosthetic aortic valve. Purpose The aim of this meta-analysis is to compare the two interventions regarding echocardiographic, post-intervention parameters, in order to assess valve hemodynamics. Methods A systematic search was performed in 3 different databases (PubMed, Web of Science, Scopus) from their inception until June 2023. All trials, which met the prespecified inclusion criteria, were included to the meta-analysis, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and a random effect meta-analysis was then performed. Results A total of 26 studies were included. The total population of this analysis included 17,581 patients, out of which 9,163 underwent ViV-TAVI and 8,418 underwent reSAVR. Post procedural echocardiography showed that patients in the ViV-TAVI had greater mean aortic valve (AV) gradient, compared to the reSAVR arm mean difference: 0.72, 95% Confidence Interval (CI): 0.30-1.14. Furthermore, post-intervention paravalvular leak was also significantly increased after ViV-TAVI Relative Risk (RR): 2.89; 95%CI: 1.79 to 4.66. Finally, ViV-TAVI was associated with greater risk for developing patient-prosthesis mismatch (PPM) (RR: 1.68; 95%CI: 0.74-3.81), as well as for severe PPM (RR: 1.62; 95%CI: 1.04-2.52). Conclusion This metanalysis shows that ViV-TAVI results in suboptimal valve hemodynamics, compared to reSAVR. As pre-procedural planning and valve technology for ViV procedures continues to emerge, future ViV-TAVI interventions should aim in the best achievable valve implantation utilizing such tools, in order to ensure proper valve function, dynamics and potentially and enhanced valve longevity.

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