Outcomes of Supra-Annular vs Intra-Annular Self-Expanding Valves in Valve-In-Valve Transcatheter Aortic Valve Replacement.

BACKGROUND: Self-expanding valves appear to have superior hemodynamics compared with balloon-expandable valves for valve-in-valve transcatheter aortic valve replacement (ViV-TAVR). OBJECTIVES: This study aimed to compare echocardiographic and clinical outcome data between supra-annular self-expanding valves (SASEVs) and intra-annular self-expanding valves (IASEVs), which in the past has remained limited, raising the need for further evaluation. METHODS: We analyzed ViV-TAVR procedures in the ACOR (Australian Cardiovascular Outcomes Registry). Patients receiving SASEV or IASEV were included. Baseline clinical and echocardiographic characteristics and postprocedure and 12-month outcomes were assessed. Echocardiographic parameters included gradients and left ventricular ejection fraction. Clinical outcomes included major adverse cardiac and cerebrovascular events, defined according to Valve Academic Research Consortium criteria. RESULTS: A total of 683 patients underwent ViV-TAVR: 566 (82.9%) with SASEV and 117 (17.1%) with IASEV. Baseline demographics were similar, although IASEV had higher rates of heart failure and a higher rate of baseline bioprosthetic valve regurgitation. Postprocedure echocardiographic findings were similar in both groups, with comparable mean gradients (14.9 mm Hg vs 13.3 mm Hg; P = 0.070), peak atrioventricular velocities (2.5 m/s vs 2.4 m/s; P = 0.073) and Dimensionless Performance Index (SASEV 0.4 vs IASEV 0.5; P < 0.001). At 12 months, although not statistically significant, there was a numerical trend toward higher major adverse cardiac and cerebrovascular events (11.9% vs 7.1%; P = 0.129) and stroke rates (5.4% vs 1.7%; P = 0.058) in the IASEV group. No significant differences were observed in mortality or bleeding. Findings were consistent after propensity score adjustment and multivariable logistic regression. CONCLUSIONS: Both SASEV and IASEV provide favorable and similar hemodynamic and clinical outcomes following ViV-TAVR.