Does Valve-in-Valve TAVI improve outcomes compared to redo SAVR in patients with degenerated biological aortic prostheses?
ViV TAVI is a viable, less invasive alternative to redo SAVR for high-risk patients with degenerated biological prostheses, but requires specialized expertise and further comparative trials.
Surgical aortic valve replacement (SAVR) is still the gold-standard treatment for aortic stenosis. However, the increasing use of biological prostheses, even in young patients, makes Valve-in-Valve (ViV) transcatheter aortic valve implantation (TAVI) an attractive option compared to redo SAVR, thanks to its lower invasiveness and sometimes greater safety. However, there are several technical and anatomical aspects to consider. Therefore, the aim of our review is to examine the main mechanisms responsible for the degeneration of biological prostheses and, subsequently, to analyze the hemodynamic (transvalvular gradients, patient-prosthesis mismatch, paravalvular leakage) and technical (risk of coronary obstruction, prosthetic implantation strategy) aspects that most influence the procedure's success and long-term outcomes. To this end, we present a case we treated in order to enhance our readers' experience with this procedure. Currently, ViV TAVI is approved for patients at high surgical risk, but it could become a valid option compared to redo SAVR; however, more clinical trials are needed to better analyze the survival differences between these two procedures. Furthermore, it remains a therapeutic strategy reserved for highly specialized centers due to the technical difficulties involved in its execution.
Torre et al. (Sat,) studied this question.