Pouya Ebrahimi, Maryam Taheri, Mehrdad Mahalleh, Hamidreza Soleimani, Homa Taheri, Ali Moradi, Babak Sattartabar, Morvarid Taebi, Iman Bhia, Reza Pirdehghan, Mohsen Anafje, Mohamad Alkhouli, Masih Tajdini, Amr Mohsen, Islam Elgendy, Robert J Siegel, Mohammad Hossein Mandegar, Kaveh Hosseini
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.
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.