Redo surgical aortic valve replacement versus valve-in-valve transcatheter aortic valve replacement with balloon valve fracture: Short-term clinical outcomes.

Abstract

Objective: To evaluate short-term outcomes of redo surgical aortic valve replacement (SAVR) versus valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) with bioprosthetic valve fracture (ViVBVF) in patients with bioprosthetic structural valve deterioration undergoing reintervention.

Methods: This retrospective single-center study was conducted between 2015 and 2025. Data were obtained from institutional registries. A total of 128 consecutive patients met the inclusion criteria (75 with redo-SAVR and 53 with ViVBVF). Patients requiring concomitant cardiac procedures, mechanical valves, or unsuitable anatomy for ViV were excluded. The primary endpoints were 30-day mortality, stroke, and readmission; secondary endpoints included echocardiographic changes and postoperative complications. Overlap propensity score weighting to adjust baseline differences was performed.

Results: Compared to the redo-SAVR patients, the ViVBVF patients were older and had a higher predicted risk of mortality. The rates of 30-day mortality, stroke, and readmission were similar in the 2 groups. ViVBVF achieved significantly greater reductions in mean gradient (-26.0 mm Hg vs -17.4 mm Hg; P =.003), peak gradient (-39.2 mm Hg vs -23.3 mm Hg; P =.004), and peak velocity. After matching, 30-day mortality was higher after redo-SAVR (8.9% vs 0%; P < .001). The ViVBVF group showed a greater reduction in peak velocity but more frequent pacemaker implantation.

Conclusions: In patients with bioprosthetic valves requiring reintervention, ViVBVF offers greater gradient reduction, with a perioperative safety advantage suggested in the adjusted analysis.