Transcatheter aortic valve-in-valve implantation for failed surgical aortic bioprostheses using the Navitor platform: early outcomes in a consecutive single-center cohort.

Abstract

Introduction: Transcatheter heart valve implantation into a failed surgical heart valve (THV-in-SHV) is an established reintervention strategy for degenerated aortic bioprostheses; however, early procedural outcomes, discharge hemodynamics, and standardized safety remain clinically relevant in routine practice.

Material and methods: We retrospectively analyzed consecutive patients who underwent aortic THV-in-SHV with the Navitor platform between 2022 and 2025. The primary endpoint was the mean aortic gradient at discharge. Secondary endpoints included peak gradient, maximum transvalvular velocity (Vmax), paravalvular leak (PVL), Valve Academic Research Consortium-3 (VARC-3) early safety, and time from surgical aortic valve replacement (SAVR) to reintervention according to leaflet mounting.

Results: Thirty patients were included (age, 72.5 ± 9.2 years; 73.3% male). At discharge, the mean and peak aortic gradients were 16.8 ± 6.7 mmHg and 30.0 ± 11.7 mmHg, respectively. Paravalvular leak was absent, trace, or mild in 96.7%, with no severe PVL. Early safety according to VARC-3 was achieved in 86.7%. Mortality and stroke occurred in 3.3% each, and bleeding type ≥ 2 occurred in 6.7%. No acute kidney injury (AKI) stage 3, renal replacement therapy (RRT), major vascular complications, device-related intervention, or new permanent pacemaker implantation occurred. Smaller surgical valves were associated with higher residual gradients, whereas outside-mounted bioprostheses showed a shorter time to reintervention than inside-mounted designs.

Conclusions: Aortic THV-in-SHV with the Navitor platform was associated with acceptable discharge hemodynamics, low rates of clinically relevant PVL, and favorable early safety according to VARC-3. Residual gradients were driven primarily by surgical valve size despite the intra-annular design.