Valve‐in‐Valve for Degenerated Transcatheter Aortic Valve Replacement Versus Valve‐in‐Valve for Degenerated Surgical Aortic Bioprostheses: A 3‐Center Comparison of Hemodynamic and 1‐Year Outcome

Background As transcatheter aortic valve replacement ( TAVR ) is expected to progress into younger patient populations, valve‐in‐TAVR (Vi TAVR ) may become a frequent consideration. Data on Vi TAVR , however, are limited. This study investigated the outcome of Vi TAVR in comparison to valve in surgical aortic valve replacement (Vi SAVR ), because Vi SAVR is an established procedure for higher‐risk patients requiring repeated aortic valve intervention. Methods and Results Clinical and procedural data of patients who underwent Vi TAVR at 3 sites in the United States and Germany were retrospectively compared with data of patients who underwent Vi SAVR at Cedars‐Sinai Medical Center, according to Valve Academic Research Consortium‐2 criteria. A total of 99 consecutive patients, 52.5% women, with a median Society of Thoracic Surgeons score of 7.2 were identified. Seventy‐four patients (74.7%) underwent Vi SAVR , and 25 patients (25.3%) underwent Vi TAVR . Balloon‐expandable devices were used in 72.7%. Vi SAVR patients presented with smaller index devices (21.0 versus 26.0 mm median true internal diameter; P <0.001). Significantly better postprocedural hemodynamics (median prosthesis mean gradient, 12.5 [interquartile range, 8.8–16.2] versus 16.0 [interquartile range, 13.0–20.5] mm Hg; P =0.045) were observed for Vi TAVR compared with the Vi SAVR . Device success, however, was not different (79.2% and 66.2% for Vi TAVR and Vi SAVR , respectively; P =0.35), as were rates of permanent pacemaker implantation (16.7% versus 5.4%; P =0.1). One‐year‐mortality was 9.4% and 13.4% for Vi TAVR and Vi SAVR , respectively (log‐rank P =0.38). Conclusions Compared with Vi SAVR , Vi TAVR provides acceptable outcomes, with slightly better hemodynamics, similar device success rates, and similar 1‐year mortality.