Treatment selection and long-term survival in patients aged 50 to < 75 years undergoing valve reintervention for failed surgical aortic bioprostheses: insights from the Netherlands Heart Registration

Q: What are the key findings of this study?

ViV-TAVI was predominantly selected for higher-risk patients and yielded a 74.4% 4-year survival, while redo-SAVR was used in lower-risk candidates and showed an 88.4% 4-year survival.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Failed surgical aortic bioprostheses (n=345). Intervention: Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) vs. Redo surgical aortic valve replacement (redo-SAVR). Primary outcome: All-cause survival at 4 years.

Q: What does this research mean for the field?

In patients aged 50 to < 75 years with failed surgical aortic bioprostheses, ViV-TAVI is predominantly selected for older patients with higher surgical risk and comorbidity burden, while lower-risk candidates more frequently receive redo-SAVR and display higher observed 4-year survival. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To describe real-world treatment allocation and long-term survival in patients aged 50 to < 75 years undergoing ViV-TAVI or redo-SAVR for failed surgical aortic bioprostheses in the Netherlands.

Antigone Kostea; Jenna van Niekerk; Lucas Uchoa de Assis; Rik Adrichem; Marijke J. C. Timmermans; Pim A.L. Tonino; Michiel Voskuil; Arend de Weger; Fabiano Porta; Isabella Kardys; Nicolas M. Van Mieghem; Rutger-Jan M. Nuis

doi:10.1007/s00392-026-03045-8

October 19, 2026Clinical Research in CardiologyOpen Access

Treatment selection and long-term survival in patients aged 50 to < 75 years undergoing valve reintervention for failed surgical aortic bioprostheses: insights from the Netherlands Heart Registration

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Key result

ViV-TAVI shows ~74% 4-year survival in higher-risk patients compared to ~88% with redo-SAVR.

n=345

Why the study?

Real-world treatment allocation and long-term survival after valve-in-valve TAVI or redo surgical AVR for failed surgical aortic bioprostheses in patients aged 50 to <75 years were not well described.

Does valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) impact long-term survival compared to redo surgical aortic valve replacement (redo-SAVR) in patients aged 50 to <75 years with failed surgical bioprostheses?

Key Points

To describe real-world treatment allocation and long-term survival in patients aged 50 to < 75 years undergoing ViV-TAVI or redo-SAVR for failed surgical aortic bioprostheses in the Netherlands.
Identified 345 patients aged 50 to < 75 years who underwent ViV-TAVI (n = 141) or redo-SAVR (n = 204) between 2015 and 2020 from the Netherlands Heart Registration.
Identified determinants of ViV-TAVI selection using multivariable logistic regression and evaluated all-cause mortality using Kaplan–Meier survival curves and treatment-specific multivariable Cox proportional hazards models.
Patients selected for ViV-TAVI were older (median 71 vs. 67 years, p < 0.001) and had higher surgical risk (median EuroSCORE II: 6.2% vs. 4.6%, p = 0.014) than redo-SAVR patients.
Estimated survival was 94.2% at 30 days, 89.6% at 2 years, and 74.4% at 4 years for ViV-TAVI, compared with 96.1%, 89.8%, and 88.4% for redo-SAVR.
Left ventricular ejection fraction ≤ 30% and chronic lung disease independently predicted ViV-TAVI selection (OR: 8.04, 95% CI: 2.16–29.92 and OR: 3.25, 95% CI: 1.53–6.92) and predicted all-cause mortality following redo-SAVR (HR: 15.70, 95% CI: 2.49–67.14 and HR: 4.23, 95% CI: 1.53–13.14).

Study Design

Type

Cohort (n=345)

Multicenter

Yes

Structured PICO

Does valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) impact long-term survival compared to redo surgical aortic valve replacement (redo-SAVR) in patients aged 50 to <75 years with failed surgical bioprostheses?

P

Population

345 patients aged 50 to <75 years with failed surgical aortic bioprostheses treated with either ViV-TAVI or redo-SAVR, followed for a median of approximately 4 years.

E

Exposure

Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI), including isolated valve procedures and those combined with percutaneous coronary intervention (PCI).

C

Comparator

Redo surgical aortic valve replacement (redo-SAVR), including isolated surgical valve replacements and combined procedures involving coronary artery bypass grafting (CABG), aortic surgery, or additional valve interventions.

O

Outcome

Treatment allocation factors and long-term all-cause survival (up to 4 years, median follow-up of 49-51 months).hard clinical

Main Result

Absolute Event Rate: 74.4% vs 88.4%

In younger patients requiring bioprosthetic aortic valve reintervention, ViV-TAVI is primarily selected for those with high clinical risk and more comorbidities, precluding a direct comparison of long-term outcomes with the lower-risk redo-SAVR cohort.

Limitations

Registry was not specifically designed for valve reinterventions
Lack of data on prosthesis size, mechanism of failure, and root/coronary anatomy
Absence of a formal multidomain frailty assessment
Potential residual confounding precludes direct comparative efficacy estimation
Treatment-specific mortality models were exploratory due to a limited number of events
In-hospital CVA outcome was not available for the redo-SAVR cohort
Registry not specifically designed for valve reinterventions
Missing mechanism of failure, failed-prosthesis size/design, anatomy, and technical considerations
No formal multidomain frailty assessment
Centre identifiers and intervention year unavailable to account for temporal/centre variation
Informative censoring or differences in follow-up cannot be excluded
In-hospital CVA data unavailable for the redo-SAVR cohort
Treatment-specific mortality models were exploratory due to low number of deaths
Excluded conservatively managed patients

Implication

Selection bias confounds survival comparisons; randomized trials needed to assess ViV-TAVI versus redo-SAVR in comparable younger patients.

Abstract

Objectives To describe real-world treatment allocation and observed long-term survival in patients aged 50 to < 75 years with failed surgical aortic bioprostheses who underwent reintervention through valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) or redo surgical aortic valve replacement (redo-SAVR) in the Netherlands. Methods Patients aged 50 to < 75 years who underwent ViV-TAVI or redo-SAVR for a failing surgical bioprosthesis between 2015 and 2020 were identified from the Netherlands Heart Registration. Baseline characteristics and Dutch surgical-risk categories were compared by treatment strategy. Multivariable logistic regression was used to identify factors associated with ViV-TAVI selection. Kaplan–Meier analysis described survival, and treatment-specific Cox models explored factors associated with all-cause mortality. Results Of 345 patients, 41% underwent ViV-TAVI and 59% redo-SAVR. Patients selected for ViV-TAVI were older (median 71 vs. 67 years, p < 0.001), had higher surgical risk (EuroSCORE II: 6.2% vs. 4.6%, p = 0.014), and had a greater comorbidity burden than redo-SAVR patients. Despite these baseline risk differences, estimated survival within the ViV-TAVI cohort was 94.2% at 30 days, 89.6% at 2 years, and 74.4% at 4 years; corresponding redo-SAVR estimates were 96.1%, 89.8%, and 88.4%. Left ventricular ejection fraction ≤ 30% and chronic lung disease were associated both with ViV-TAVI selection (OR: 8.04, 95% CI: 2.16–29.92 and OR: 3.25, 95% CI: 1.53–6.92, respectively) and with all-cause mortality after redo-SAVR (HR: 15.70, 95% CI: 2.49–67.14 and HR: 4.23, 95% CI: 1.53–13.14, respectively). Conclusion In this Dutch observational registry, ViV-TAVI was predominantly selected for patients with a higher-risk clinical phenotype, while redo-SAVR was more often used in lower-risk reintervention candidates and showed higher observed long-term survival. These data describe contemporary treatment selection and prognosis but do not establish comparative superiority of either strategy.

Discussion

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Cite This Study

Kostea et al. (2026) conducted a cohort in Failed surgical aortic bioprostheses (n=345). Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) vs. Redo surgical aortic valve replacement (redo-SAVR) was evaluated on All-cause survival at 4 years. ViV-TAVI was predominantly selected for higher-risk patients and yielded a 74.4% 4-year survival, while redo-SAVR was used in lower-risk candidates and showed an 88.4% 4-year survival.

synapsesocial.com/papers/6ad75065437c59c3d858a3ef https://doi.org/10.1007/s00392-026-03045-8

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Treatment selection and long-term survival in patients aged 50 to < 75 years undergoing valve reintervention for failed surgical aortic bioprostheses: insights from the Netherlands Heart Registration

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Treatment selection and long-term survival in patients aged 50 to < 75 years undergoing valve reintervention for failed surgical aortic bioprostheses: insights from the Netherlands Heart Registration

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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