Key result
Redo-TAVI linked to ~30% lower 1-year mortality vs surgical TAVI-explantation, despite higher paravalvular leak risk.
Why the study?
As TAVI expands to younger and lower-risk populations, failed transcatheter heart valves are increasingly encountered, but the optimal reintervention strategy remains uncertain.
Does redo-TAVI improve all-cause mortality compared to surgical explantation in patients with failed transcatheter heart valves?
Meta-Analysis (n=6,166)
Does redo-TAVI improve all-cause mortality compared to surgical explantation in patients with failed transcatheter heart valves?
Odds Ratio: 0.7 (95% CI 0.62–0.8)
p-value: p=<0.0001
Redo-TAVI is associated with significantly lower early and 1-year mortality, reduced bleeding, and shorter hospital stays compared to surgical explantation, supporting its use as the preferred reintervention strategy in anatomically suitable patients despite a higher risk of paravalvular leak.
Redo-TAVI was associated with lower short-term mortality than explantation; supports Heart Team selection but leaves optimal strategy open pending RCTs.
Background As transcatheter aortic valve implantation (TAVI) expands to younger and lower‐risk populations, failed transcatheter heart valves are increasingly encountered, yet the optimal reintervention strategy remains uncertain. This meta‐analysis aimed to compare the outcomes of redo‐TAVI (TAVI‐in‐TAVI) versus surgical transcatheter heart valve explantation with surgical aortic valve replacement (TAVI‐explantation) after transcatheter heart valve failure. Methods PubMed/Medline, Scopus and Cochrane Central Register of Controlled Trials were systematically searched from inception to September 10, 2025 for comparative studies. The primary outcome was all‐cause mortality (in‐hospital, 30‐day, and 1‐year). Secondary outcomes included cerebrovascular events, major adverse cardiac events, permanent pacemaker implantation, greater‐than‐mild paravalvular leak, major bleeding, length of stay, and 30‐day readmission. As the primary analysis, reconstructed individual patient‐level data were analyzed using Firth penalized logistic regression adjusting for study, and complementary random‐effects meta‐analyses were also used. Results Eight observational studies including 6166 patients (3743 redo‐TAVI; 2425 TAVI‐explantation) were analyzed. Compared with TAVI‐explantation, redo‐TAVI was associated with lower in‐hospital mortality (odds ratio [OR], 0.20 [95% CI, 0.11–0.35]; P <0.0001), 30‐day mortality (OR, 0.28 [95% CI, 0.23–0.34]; P <0.0001), and 1‐year mortality (OR, 0.70 [95% CI, 0.62–0.80]; P <0.0001). No significant differences were observed in cerebrovascular events or permanent pacemaker implantation rates. Redo‐TAVI was associated with lower major bleeding (OR, 0.35 [95% CI, 0.24–0.50]; P <0.0001), fewer 30‐day readmissions (OR, 0.53 [95% CI, 0.30–0.92]; P =0.023), and shorter hospitalization (Mean Difference −6.29 days [95% CI, −8.66 to −3.93), but a higher risk of greater‐than‐mild paravalvular leak (OR, 80.12 [95% CI, 11.30–10 153]; P <0.0001). Conclusions Redo‐TAVI was associated with lower early and 1‐year mortality, reduced bleeding, and shorter hospitalization compared with TAVI‐explantation, with similar cerebrovascular event and permanent pacemaker implantation rates but higher paravalvular leak risk. These findings support redo‐TAVI as the preferred reintervention strategy in anatomically suitable patients, whereas randomized trials and longer‐term follow‐up are needed to refine lifetime management strategies after transcatheter heart valve failure.
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Ktenopoulos et al. (2026) conducted a meta-analysis in Failed transcatheter heart valves (n=6,166). Redo-transcatheter aortic valve implantation (redo-TAVI) vs. Surgical transcatheter heart valve explantation with surgical aortic valve replacement was evaluated on All-cause mortality (in-hospital, 30-day, and 1-year) (OR 0.70, 95% CI 0.62-0.80, p=<0.0001). Redo-TAVI was associated with lower 1-year mortality compared with surgical TAVI-explantation (OR 0.70; 95% CI 0.62-0.80; P<0.0001), alongside reduced bleeding but higher paravalvular leak risk.