Key result
ViV-TAVI shows worse valve hemodynamics vs reSAVR, including ~189% higher PVL risk and increased PPM.
Why the study?
To compare post-intervention echocardiographic parameters and valve hemodynamics between ViV-TAVI and reSAVR for degenerated bioprosthetic aortic valves.
Does ViV-TAVI improve post-procedural valve hemodynamics compared to reSAVR in patients with a degenerated bioprosthetic aortic valve?
Meta-Analysis (n=17,581)
Does ViV-TAVI improve post-procedural valve hemodynamics compared to reSAVR in patients with a degenerated bioprosthetic aortic valve?
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.
Answers are grounded in this paper and cite their sources.
ViV-TAVI may yield inferior hemodynamics versus reSAVR; leaves open optimal strategy pending randomized outcome data.
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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Pyrpyris et al. (2025) conducted a meta-analysis in Degenerated, surgically implanted, bioprosthetic aortic valve (n=17,581). Valve in Valve Transcatheter Aortic Valve Implantation (ViV-TAVI) vs. Repeat surgery (reSAVR) was evaluated on Mean aortic valve (AV) gradient (MD 0.72, 95% CI 0.30-1.14).
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