Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Isolated Redo Surgical Aortic Valve Replacement

This study compared outcomes between patients undergoing valve-in-valve transcatheter aortic valve replacement (ViV TAVR) and redo surgical aortic valve replacement (redo SAVR) using a retrospective analysis of institutional databases, which included data from 2013 to 2022 for TAVR and 2011 to 2022 for SAVR. A total of 198 patients underwent ViV TAVR and 147 patients underwent redo SAVR. Both groups had an operative mortality rate of 2 percent, but the observed-to-expected operative mortality ratio was higher in the redo SAVR group (1.2) compared to ViV TAVR (0.32). Patients in the redo SAVR group were more likely to experience complications, including transfusions, reoperations for bleeding, new onset renal failure requiring dialysis, and the need for permanent pacemakers.  Echocardiographic outcomes showed that the mean gradient across the aortic valve was significantly lower in the redo SAVR group at both postoperative day 30 and one year. Survival estimates for one year were similar for both procedures, and multivariable Cox regression indicated no significant difference in mortality risk between the two groups (hazard ratio 1.39, 95 percent CI 0.65-2.99; P = .40). However, heart failure readmission rates were higher in the ViV cohort.  While both ViV TAVR and redo SAVR demonstrated comparable mortality rates, the redo SAVR group had better mean gradients and lower rates of heart failure readmissions but faced more postoperative complications. These findings suggest that despite a higher risk profile, redo SAVR may offer certain advantages over ViV TAVR in selected patients.