Transcatheter aortic valve-in-valve implantation in Poland: A nationwide analysis of 454 patients from the KROK registry linked with the national mortality database (2012–2025)

Q: What are the key findings of this study?

Transcatheter aortic valve-in-valve implantation for degenerated bioprostheses demonstrated a 30-day all-cause mortality of 2.6% and a 1-year overall survival of 91.3%.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Degenerated aortic bioprostheses (n=454). Intervention: Transcatheter aortic valve-in-valve implantation (TAVI ViV). Primary outcome: 30-day all-cause mortality.

Q: What does this research mean for the field?

Transcatheter aortic valve-in-valve implantation for degenerated bioprostheses achieves low short-term mortality (2.6% at 30 days) and favorable medium-term survival (91.3% at 1 year) despite significant increases in patient operative risk since initial surgical replacement. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Marek Reszczyński; Radosław Litwinowicz; Maciej Brzeziński; Bartłomiej Perek; Kazimierz Widenka; Łukasz Jaworski; Krzysztof Greberski; Michalina Malec-Litwinowicz; Marian Burysz

doi:10.33963/v.phj.115086

September 30, 2026Kardiologia PolskaOpen Access

Transcatheter aortic valve-in-valve implantation in Poland: A nationwide analysis of 454 patients from the KROK registry linked with the national mortality database (2012–2025)

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Key result

Aortic valve-in-valve TAVI shows ~91% 1-year survival for degenerated bioprostheses.

n=454

Why the study?

Contemporary nationwide data on transcatheter aortic valve-in-valve implantation (TAVI ViV) in Poland linked to a national mortality register were not available.

Key Points

To evaluate national outcomes of transcatheter aortic valve-in-valve implantation (TAVI ViV) and characterize the change in patient clinical status and operative risk between the initial surgical aortic valve replacement and ViV.
Analyzed N=454 patients undergoing TAVI ViV between 2012 and 2025 across 27 centers using the Polish National Registry of Cardiac Surgical Procedures (KROK) linked with the national mortality register.
Performed within-patient comparisons of clinical status between index surgical AVR and TAVI ViV using Wilcoxon signed-rank and McNemar tests, and estimated survival using the Kaplan–Meier method.
Transfemoral access was utilized in 97.8% of procedures; 30-day all-cause mortality was 2.6% and complications occurred in 7.7%, with overall survival of 91.3% at 1 year, 80.2% at 3 years, and 70.0% at 5 years.
Over a median 8.8-year interval from surgical AVR to ViV, median EuroSCORE II rose from 1.2% to 5.7%, median left ventricular ejection fraction decreased from 60.0% to 50.0%, and chronic kidney disease prevalence increased from 22.2% to 68.9% (all P <0.001).
Multivariable Cox regression demonstrated that EuroSCORE II (HR 1.04 per 1%, 95% CI 1.02–1.06, P <0.001) and diabetes (HR 1.73, 95% CI 1.13–2.66, P = 0.01) were independently associated with overall mortality.

Study Design

Type

Cohort (n=454)

Multicenter

Yes

Structured PICO

P

Population

454 adult patients (mean age 73.9 years, 46.5% female) with degenerated surgical aortic bioprostheses who underwent transcatheter aortic valve-in-valve implantation, followed for a median of 24.7 months.

E

Exposure

Transcatheter aortic valve-in-valve implantation (TAVI ViV)

O

Outcome

30-day all-cause mortality after TAVI ViV, and overall survival from the date of TAVI ViV to death or administrative censoringhard clinical

Limitations

Based on administrative registry data lacking structured clinical follow-up, such as serial echocardiography.
Only all-cause mortality is reported; event-specific VARC-3 endpoints could not be analyzed.
Missing data for bioprosthesis type (11.9%) and transcatheter valve model (23.1%), predominantly in earlier eras.
Comparisons with redo-surgical aortic valve replacement were not performed.
Kaplan-Meier survival estimates rely on the assumption of non-informative censoring.
Likely under-reporting of post-discharge permanent pacemaker implantation.
Based on administrative registry data lacking structured clinical follow-up (no echo data, VARC-3 criteria cannot be determined)
Only all-cause mortality reported
Missing data for bioprosthesis type (11.9%) and transcatheter valve model (23.1%)
No comparison with redo-surgical AVR
Assumption of non-informative censoring
Likely under-reporting of post-discharge pacemaker implantation

Implication

TAVI ViV in Poland demonstrates a favorable safety profile and mid-term survival, supporting its use as an alternative to redo surgery in patients whose operative risk significantly increases after initial surgical AVR.

Abstract

Background: Transcatheter aortic valve-in-valve implantation (TAVI ViV) is an established alternative to redo surgical aortic valve replacement (AVR) for degenerated bioprostheses. Contemporary nationwide data on TAVI ViV in Poland linked to a national mortality register are not available. Aims: The aim of this study was to describe the contemporary Polish experience with TAVI ViV and how patients’ clinical status changed between the index AVR and TAVI ViV. Methods: Patients undergoing TAVI ViV between 2012 and 2025 were identified from the Polish National Registry of Cardiac Surgical Procedures (KROK) and linked to the national mortality register. Within-patient comparisons used the Wilcoxon signed-rank and McNemar tests; survival was estimated by the Kaplan–Meier method. Results: Four hundred fifty-four patients were included (mean age 73.9 years; 53.5% male; median EuroSCORE II 5.7%). The median interval from AVR to ViV was 8.8 years and transfemoral access was used in 97.8% of procedures. The 30-day all-cause mortality was 2.6% and the complication rate 7.7%. Overall survival was 91.3% at 1 year, 80.2% at 3 years, and 70.0% at 5 years. From AVR to ViV, median EuroSCORE II rose from 1.2% to 5.7%, median left ventricular ejection fraction declined from 60.0% to 50.0%, and chronic kidney disease prevalence increased from 22.2% to 68.9% (all P <0.001). Across 27 centers, the analysis was underpowered to assess the volume–mortality relationship. Conclusions: TAVI ViV in Poland is performed with safety comparable to leading international registries. The marked rise in operative risk between AVR and TAVI ViV supports a transcatheter rather than redo-surgical approach to bioprosthesis failure.

Discussion

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Cite This Study

Reszczyński et al. (2026) conducted a cohort in Degenerated aortic bioprostheses (n=454). Transcatheter aortic valve-in-valve implantation (TAVI ViV) was evaluated on 30-day all-cause mortality. Transcatheter aortic valve-in-valve implantation for degenerated bioprostheses demonstrated a 30-day all-cause mortality of 2.6% and a 1-year overall survival of 91.3%.

synapsesocial.com/papers/6ac19d70aeea5716e8c6c66b https://doi.org/10.33963/v.phj.115086

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Transcatheter aortic valve-in-valve implantation in Poland: A nationwide analysis of 454 patients from the KROK registry linked with the national mortality database (2012–2025)

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Transcatheter aortic valve-in-valve implantation in Poland: A nationwide analysis of 454 patients from the KROK registry linked with the national mortality database (2012–2025)

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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