Comparing short- and long-term outcomes of transcatheter valve-in-valve versus redo surgical aortic valve replacement: a literature review

Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) and redo-surgical aortic valve replacement (redo-SAVR) are two primary strategies for managing degenerated bioprosthetic aortic valves. ViV-TAVR has gained prominence due to its minimally invasive nature, shorter recovery time, and reduced perioperative risk, making it preferable for high-risk patients with multiple comorbidities. In contrast, redo-SAVR remains the gold standard for younger, lower-risk patients because of its superior long-term durability, lower residual gradients, and decreased risk of patient-prosthesis mismatch (PPM). ViV-TAVR and redo-SAVR are key strategies for managing degenerated bioprosthetic aortic valves. ViV-TAVR is favored for high-risk patients due to its minimally invasive nature, shorter recovery, and reduced perioperative risks, while redo-SAVR remains the gold standard for younger, lower-risk patients owing to its long-term durability and reduced risk of patient-prosthesis mismatch. Ongoing concerns regarding long-term durability, higher transvalvular gradients, and potential coronary obstruction exist. Although redo-SAVR offers better longevity, it has higher perioperative risks and longer recovery times. Across the included propensity-score matched studies and meta-analyses, long-term all-cause mortality was generally comparable between ViV-TAVR and redo-SAVR, although results were heterogeneous and some studies suggested a possible advantage for redo-SAVR in selected populations and/or with longer follow-up. However, ViV-TAVR may be associated with increased heart failure hospitalizations (HHF) after two years and redo-SAVR has superior short-term outcomes with regard to decreased myocardial infarction and PPM. Comparative studies also highlight a lower risk of atrial fibrillation (AF) and major adverse cardiovascular events (MACE) with ViV-TAVR, while redo-SAVR patients may experience better mid- to long-term survival.