Key result
Valve-in-valve TAVR lowers short-term mortality ~53% compared to redo surgical aortic valve replacement.
Why the study?
Degeneration of bioprosthetic aortic valves is common and while redo-SAVR is standard, ViV-TAVR has emerged as a less invasive alternative with unclear comparative outcomes.
Does ViV-TAVR reduce mortality and peri-procedural complications compared to redo-SAVR in patients with degenerated bioprosthetic aortic valves?
Meta-Analysis (n=16,223)
Does ViV-TAVR reduce mortality and peri-procedural complications compared to redo-SAVR in patients with degenerated bioprosthetic aortic valves?
ViV-TAVR provides significant short-term safety and mortality benefits over redo-SAVR, with comparable long-term clinical outcomes, despite higher postprocedural transvalvular gradients.
INTRODUCTION: Degeneration of bioprosthetic aortic valves is a common late complication. While redo surgical aortic valve replacement (redo-SAVR) has traditionally been the standard of care, transcatheter valve-in-valve implantation (ViV-TAVR) has emerged as a less invasive alternative. This meta-analysis aimed to compare outcomes between ViV-TAVR and redo-SAVR using propensity-score-matched studies. METHODS: A systematic search of Cochrane CENTRAL, Scopus, MEDLINE (via PubMed) Embase, and Scopus was conducted from inception through to 1 September 2024. Propensity-score matched cohort studies comparing ViV-TAVR and redo-SAVR were included. Risk ratios (RRs) and mean differences (MDs) or standardised mean differences (SMD), as appropriate, were pooled using a random-effects model. RESULTS: Thirteen propensity score-matched studies encompassing 16,223 patients (8,463 ViV-TAVR; 7,760 redo-SAVR) with a weighted mean follow-up of 16.6 months were included. Compared to redo-SAVR, ViV-TAVR was associated with significantly lower short-term all-cause mortality (RR: 0.47; 95% confidence interval [CI]: 0.34-0.66; p<0.0001), major bleeding (RR: 0.45; 95% CI: 0.33-0.59), acute kidney injury (RR: 0.56; 95% CI: 0.38-0.84), and shorter hospital stay (SMD: -0.79; 95% CI: -1.00 to -0.57). ViV-TAVR was also associated with a significantly lower incidence of new-onset atrial fibrillation (RR: 0.22; 95% CI: 0.13-0.37) but higher post-procedural mean transvalvular gradients (SMD: 0.45; 95% CI: 0.20-0.69). No significant differences were observed in 1- or ≥2-year mortality, stroke/transient ischaemic attack, myocardial infarction, permanent pacemaker implantation, or early readmission. Results remained consistent across sensitivity and subgroup analyses. CONCLUSION: ViV-TAVR offers significant short-term benefits over redo-SAVR, including lower early mortality and shorter hospitalisation. Long-term clinical outcomes remain comparable, while postprocedural mean gradients are higher after ViV-TAVR, underscoring the need for randomised trials and individualised patient selection to guide treatment decisions for degenerated bioprosthetic valves.
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Ebrahimi et al. (2026) conducted a meta-analysis in Degenerated bioprosthetic aortic valve (n=16,223). Transcatheter valve-in-valve implantation (ViV-TAVR) vs. Redo surgical aortic valve replacement (redo-SAVR) was evaluated on short-term all-cause mortality (RR 0.47, 95% CI 0.34-0.66, p=<0.0001). Transcatheter valve-in-valve implantation significantly lowered short-term all-cause mortality compared to redo surgical aortic valve replacement (RR 0.47; 95% CI 0.34-0.66; p<0.0001).
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