What is the clinical evidence from this study?

Study design: Cohort. Population: Aortic bioprosthesis failure (n=4327). Intervention: Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) vs. Redo surgical aortic valve replacement (SAVR). Primary outcome: Composite of all-cause mortality, all-cause stroke, myocardial infarction, and major or life-threatening bleeding at 30 days (OR 0.62, 95% CI 0.44-0.88, p=0.03).

What question did this study set out to answer?

To evaluate nationwide clinical outcomes of valve-in-valve transcatheter aortic valve replacement (VIV TAVR) compared with redo surgical aortic valve replacement (SAVR) for failed aortic bioprostheses.

August 18, 2026Journal of the American College of CardiologyOpen Access

Transcatheter Valve-in-Valve Aortic Valve Replacement as an Alternative to Surgical Re-Replacement

Q: What are the key findings of this study?

Valve-in-valve TAVR was associated with a lower 30-day rate of mortality, stroke, MI, and bleeding compared to redo SAVR (OR 0.62; 95% CI 0.44-0.88; p=0.03), with similar long-term outcomes.

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Key result

Valve-in-valve TAVR linked to ~38% fewer 30-day major events versus redo SAVR.

OR 0.62
95% CI 0.44-0.88
P=0.03
n=4,327

Why the study?

Clinical comparison of VIV TAVR and redo SAVR for aortic bioprosthesis failure has been limited by small patient numbers.

Does VIV TAVR improve clinical outcomes compared to redo SAVR in patients with aortic bioprosthesis failure?

Population

4,327 patients treated for aortic bioprosthesis failure (717 matched pairs analyzed)

Comparison

Isolated VIV TAVR vs redo SAVR

Design

Nationwide retrospective database study with propensity score matching

Follow-up

Median 516 days

Authors

PDPierre Deharo ABArnaud Bisson JHJulien Herbert

Discussion

Member takes

Overview

VIV TAVR was associated with better short-term outcomes than redo SAVR; leaves open need for RCTs to guide long-term choice.

Key Points

To evaluate nationwide clinical outcomes of valve-in-valve transcatheter aortic valve replacement (VIV TAVR) compared with redo surgical aortic valve replacement (SAVR) for failed aortic bioprostheses.
Nationwide observational study analyzing 4,327 patients treated for aortic bioprosthesis failure from the French administrative hospital-discharge database between 2010 and 2019.
Used propensity score matching to compare 717 matched patients receiving isolated VIV TAVR versus 717 matched patients receiving redo SAVR across a median follow-up of 516 days.
At 30 days, VIV TAVR was associated with a lower rate of the composite endpoint of all-cause mortality, stroke, myocardial infarction, and major or life-threatening bleeding (OR: 0.62; 95% CI: 0.44 to 0.88; p = 0.03).
During median follow-up of 516 days, the combined endpoint of cardiovascular death, stroke, myocardial infarction, or heart failure rehospitalization showed no significant difference between groups (OR: 1.18; 95% CI: 0.99 to 1.41; p = 0.26).
VIV TAVR had higher rates of permanent pacemaker implantation and heart failure rehospitalization, alongside a significant time-dependent interaction between all-cause and cardiovascular mortality (p-interaction < 0.05).

Study Design

Type

Cohort (n=4,327)

Multicenter

Yes

Structured PICO

Does VIV TAVR improve clinical outcomes compared to redo SAVR in patients with aortic bioprosthesis failure?

Population

4,327 patients treated for aortic bioprosthesis failure with isolated VIV TAVR or redo SAVR in France between 2010 and 2019, with 717 propensity-matched patients analyzed per group over a median 516 days.

Exposure

Isolated valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR)

Comparator

Redo surgical aortic valve replacement (SAVR)

Outcome

Composite of all-cause mortality, all-cause stroke, myocardial infarction, and major or life-threatening bleeding at 30 dayscomposite

Main Result

Odds Ratio: 0.62 (95% CI 0.44–0.88)

p-value: p=0.03

In a nationwide French cohort, VIV TAVR for aortic bioprosthesis failure was associated with better 30-day outcomes than redo SAVR, but similar long-term major cardiovascular outcomes despite higher rates of pacemaker implantation and heart failure rehospitalization.

Cite This Study

Deharo et al. (2020) conducted a cohort in Aortic bioprosthesis failure (n=4,327). Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) vs. Redo surgical aortic valve replacement (SAVR) was evaluated on Composite of all-cause mortality, all-cause stroke, myocardial infarction, and major or life-threatening bleeding at 30 days (OR 0.62, 95% CI 0.44-0.88, p=0.03). Valve-in-valve TAVR was associated with a lower 30-day rate of mortality, stroke, MI, and bleeding compared to redo SAVR (OR 0.62; 95% CI 0.44-0.88; p=0.03), with similar long-term outcomes.

synapsesocial.com/papers/6a8477e9f54da20a1578d64a https://doi.org/10.1016/j.jacc.2020.06.010

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August 18, 2026Journal of the American College of CardiologyOpen Access

Transcatheter Valve-in-Valve Aortic Valve Replacement as an Alternative to Surgical Re-Replacement

View Full Paper

Ask AI

Bookmark

Key result

Valve-in-valve TAVR linked to ~38% fewer 30-day major events versus redo SAVR.

OR 0.62
95% CI 0.44-0.88
P=0.03
n=4,327

Why the study?

Clinical comparison of VIV TAVR and redo SAVR for aortic bioprosthesis failure has been limited by small patient numbers.

Does VIV TAVR improve clinical outcomes compared to redo SAVR in patients with aortic bioprosthesis failure?

Population

4,327 patients treated for aortic bioprosthesis failure (717 matched pairs analyzed)

Comparison

Isolated VIV TAVR vs redo SAVR

Design

Nationwide retrospective database study with propensity score matching

Follow-up

Median 516 days

Authors

PDPierre Deharo ABArnaud Bisson JHJulien Herbert

Discussion

Member takes

Overview

VIV TAVR was associated with better short-term outcomes than redo SAVR; leaves open need for RCTs to guide long-term choice.

Key Points

To evaluate nationwide clinical outcomes of valve-in-valve transcatheter aortic valve replacement (VIV TAVR) compared with redo surgical aortic valve replacement (SAVR) for failed aortic bioprostheses.
Nationwide observational study analyzing 4,327 patients treated for aortic bioprosthesis failure from the French administrative hospital-discharge database between 2010 and 2019.
Used propensity score matching to compare 717 matched patients receiving isolated VIV TAVR versus 717 matched patients receiving redo SAVR across a median follow-up of 516 days.
At 30 days, VIV TAVR was associated with a lower rate of the composite endpoint of all-cause mortality, stroke, myocardial infarction, and major or life-threatening bleeding (OR: 0.62; 95% CI: 0.44 to 0.88; p = 0.03).
During median follow-up of 516 days, the combined endpoint of cardiovascular death, stroke, myocardial infarction, or heart failure rehospitalization showed no significant difference between groups (OR: 1.18; 95% CI: 0.99 to 1.41; p = 0.26).
VIV TAVR had higher rates of permanent pacemaker implantation and heart failure rehospitalization, alongside a significant time-dependent interaction between all-cause and cardiovascular mortality (p-interaction < 0.05).

Study Design

Type

Cohort (n=4,327)

Multicenter

Yes

Structured PICO

Does VIV TAVR improve clinical outcomes compared to redo SAVR in patients with aortic bioprosthesis failure?

Population

Exposure

Isolated valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR)

Comparator

Redo surgical aortic valve replacement (SAVR)

Outcome

Composite of all-cause mortality, all-cause stroke, myocardial infarction, and major or life-threatening bleeding at 30 dayscomposite

Main Result

Odds Ratio: 0.62 (95% CI 0.44–0.88)

p-value: p=0.03

Cite This Study

synapsesocial.com/papers/6a8477e9f54da20a1578d64a https://doi.org/10.1016/j.jacc.2020.06.010

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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