Overview
Prosthetic aortic valve failure necessitates revision, with options including redo surgical aortic valve replacement (redo-SAVR) and valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) 1. The choice between these techniques is debated, particularly given the increasing popularity of ViV-TAVI as a less invasive alternative 1.Management
Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) demonstrated lower 1-year mortality, acute kidney injury, bleeding, stroke, and new pacemaker implantation compared to redo-SAVR 1.
Redo-SAVR showed more favorable mean postoperative aortic valve gradients 1.
Both redo-SAVR and ViV-TAVI exhibited similar procedural and short-term mortality 1.Key Recommendations
Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is associated with lower 1-year mortality, acute kidney injury, bleeding, stroke, and new pacemaker implantation compared to redo-SAVR 1. (Evidence: Moderate)
Redo surgical aortic valve replacement (redo-SAVR) may result in more favorable postoperative aortic valve gradients 1. (Evidence: Moderate)
Short-term mortality is similar between ViV-TAVI and redo-SAVR for failed bioprostheses 1. (Evidence: Moderate)References
1 Comentale G, Ahmadi-Hadad A, Moldon HJ, Carbone A, Manzo R, Franzone A et al.. Transcatheter aortic valve implantation vs. surgery for failed bioprosthesis: a meta-analysis of over 20 000 patients. Journal of cardiovascular medicine (Hagerstown, Md.) 2025. link