In-hospital outcomes of valve-in-valve vs. native valve transcatheter aortic valve implantation in Brazil: A propensity-matched analysis

INTRODUCTION: Transcatheter aortic valve implantation (TAVI) has become the standard of care for elderly patients with severe aortic stenosis. While valve-in-valve TAVI (ViV-TAVI) offers a less invasive alternative to redo surgery in patients with degenerated surgical heart valves (SHV), evidence remains limited. METHODS: This is a retrospective study based on a Brazilian clinical registry of TAVI patients between January 2009 and December 2021. We compared ViV-TAVI patients with native aortic valve (NV-TAVI) patients. Temporal trends, procedural, and in-hospital outcomes were evaluated. We performed propensity score matching (PSM) and multivariable regression to adjust comparisons. RESULTS: Among 3194 patients from 25 centers, 135 underwent ViV-TAVI. The ViV volume increased slightly over time in proportion to NV-TAVI. After PSM, there were 127 ViV and 248 NV-TAVI patients. ViV patients had lower device success (71.7% vs. 87.9%; OR 0.35; 95% CI 0.20-0.60; p < 0.01) and permanent pacemaker implantation (4.7% vs. 12.9%; OR 0.35; 95% CI 0.13-0.79; p < 0.01) compared with NV-TAVI. Valve embolization was more frequent in ViV-TAVI (3.9% vs. 0.8%; OR 4.44; 95% CI 1.03-25.59; p = 0.04). Among ViV patients, no difference in embolization risk was detected (OR 1.11; 95% CI 0.18-11.80; p = 0.91) between radiopaque vs. radiolucent SHV. Major vascular complications, major or life-threatening bleeding, stroke, and in-hospital mortality did not differ significantly between groups. CONCLUSION: During the study period, a modest but significant increase was observed in the number of ViV-TAVI procedures. Device success and PPI were lower, and valve embolization was more frequent in ViV-TAVI compared with NV-TAVI. In-hospital safety outcomes did not differ between groups.