Key result
Valve-in-valve transcatheter aortic valve replacement showed similar 3-year all-cause mortality compared to redo surgical aortic valve replacement (22.1% vs 17.7%; P=0.37).
Why the study?
ViV-TAVR and Re-SAVR show similar short-term safety and efficacy for degenerated aortic bioprostheses, but long-term survival and haemodynamic performance data are limited.
Does valve-in-valve transcatheter aortic valve replacement reduce all-cause deaths compared to redo surgical aortic valve replacement in patients with degenerated aortic bioprostheses?
Cohort (n=266)
Yes
Does valve-in-valve transcatheter aortic valve replacement reduce all-cause deaths compared to redo surgical aortic valve replacement in patients with degenerated aortic bioprostheses?
Answers are grounded in this paper and cite their sources.
In patients with degenerated aortic bioprostheses, ViV-TAVR and Re-SAVR offer similar 3-year mortality and haemodynamic outcomes, though ViV-TAVR is associated with fewer early complications.
BACKGROUND: Management of degenerated aortic bioprostheses through valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) or redo surgical aortic valve replacement (Re-SAVR) shows similar short-term safety and efficacy. However, long-term survival and haemodynamic performance data are limited. AIM: To compare clinical characteristics, haemodynamics and outcomes at 3 years between ViV-TAVR and Re-SAVR techniques. METHODS: This retrospective two-centre study included 266 patients treated for isolated aortic bioprosthesis degeneration (130 Re-SAVR, 136ViV-TAVR) from 2009 to 2018, with up to 3 years of follow-up. RESULTS: The ViV-TAVR group was older (83 vs. 77 years; P=0.005) with higher surgical risk (Logistic EuroSCORE 22% vs. 13%; P=0.005). At 3 years, univariate analysis showed no significant difference in all-cause deaths (22.1% vs. 17.7%; P=0.37). ViV-TAVR was associated with fewer first-month complications, including major bleeding (11.0% vs. 52.3%; P=0.007) and acute renal failure grade 2/3 (5.1% vs. 14.6%; P=0.053). Inverse probability of treatment weighting analysis revealed no difference in all-cause deaths at 1 year (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.36-1.67; P=0.52) or between 1 and 3 years (HR 1.56, 95% CI 0.82-2.99; P=0.17). Composite events were similar at 1 year (HR 0.80, 95% CI 0.44-1.44; P=0.45) and between 1 and 3 years (HR 1.41, 95% CI 0.83-2.38; P=0.21). Mean gradients at 3 years were similar (16.1±11.4 vs. 13.2±5.3mmHg; P=0.17). In patients with small bioprostheses (true internal diameter≤20mm [n=151]), death rates at 3 years were similar (21.1% vs. 20.0%; P=0.86), as was haemodynamic performance (mean gradient 19.2±14.0mmHg for ViV-TAVR vs. 13.7±4.12mmHg for Re-SAVR [P=0.38]). Compared to balloon-expandable, self-expandable valves showed better 1-year mean gradients (16.4±10.5 vs. 13.7±4.12mmHg; P=0.012). CONCLUSIONS: ViV-TAVR and Re-SAVR had similar mortality and haemodynamic outcomes at 3 years, including in patients with small bioprostheses where self-expandable valves yielded the best results.
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Rosier et al. (2025) conducted a cohort in degenerated aortic bioprostheses (n=266). Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) vs. Redo surgical aortic valve replacement (Re-SAVR) was evaluated on all-cause deaths at 3 years (p=0.37). Valve-in-valve transcatheter aortic valve replacement showed similar 3-year all-cause mortality compared to redo surgical aortic valve replacement (22.1% vs 17.7%; P=0.37).
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