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. 2025 Apr 22:12:1465409.
doi: 10.3389/fcvm.2025.1465409. eCollection 2025.

Valve-in-valve transcatheter aortic valve replacement (TAVR) leads to lower device success compared to TAVR in native stenosis

Michael Paukovitsch  1 , Bartu Dilaver  1 , Dominik Felbel  1 , Marvin Krohn-Grimberghe  1 , Dominik Buckert  1 , Johannes Moerike  1 , Leonhard Moritz Schneider  1 , Christian Liewald  2 , Wolfgang Rottbauer  1 , Birgid Gonska  1
Affiliations

Valve-in-valve transcatheter aortic valve replacement (TAVR) leads to lower device success compared to TAVR in native stenosis

Michael Paukovitsch et al. Front Cardiovasc Med. .

Abstract

Background: Despite the lack of randomized-controlled trials in patients with failed bioprosthetic valves, valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is increasingly used.

Methods: Outcomes of consecutive patients treated with ViV-TAVR (N = 100) at our tertiary heart center between 2014 and 2022 were compared to TAVR (N = 2216) in native valves.

Results: Patients median age was 78.5 years (IQR 70.0-84.0) in ViV-TAVR compared to 81.0 (IQR 77.0-85.0) in patients with native aortic stenosis (p < 0.01) with a similar percentage of females in both groups (42% vs. 49.3%, p = 0.18). The median Society of Thoracic Surgeons score for mortality was significantly higher in patients undergoing ViV-TAVR [5.1% {IQR 2.6%-8.6%} vs. 3.8% {IQR 2.4%-6.3%}, p < 0.01]. ViV-TAVR was performed in degenerated surgical bioprostheses in 88% and in degenerated transcatheter bioprostheses in 12%. Stenosis was the main mechanism of bioprosthetic valve failure (70%), whereas severe regurgitation was the leading cause in 30%. The overall rate of device success amounted to 66% in ViV-TAVR, compared to 96.1% in TAVR (p < 0.01) and ViV-TAVR was independently associated with reduced device success (OR: 0.07, 95%CI: 0.045-0.12, p < 0.01) in multivariate regression. While ViV-TAVR decreased peak and mean gradients significantly, in 31% of patients elevated mean gradients (≥20 mmHg) were observed at discharge. Small native prosthesis diameter (<20 mm) was the strongest predictor (OR 3.8, 95%CI: 1.5-9.2, p = 0.01) independently associated with elevated gradients after ViV-TAVR.

Conclusion: ViV-TAVR for treatment of degenerated bioprostheses improves aortic valve function. However, device success is lower compared to TAVR in native aortic valve disease, mainly due to elevated postprocedural mean gradients, especially in small bioprostheses.

Keywords: bioprosthetic valve degeneration; bioprosthetic valve failure; device success; transcatheter aortic replacement; valve in valve aortic replacement.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(Study flowchart): overall 3,455 were treated with TAVR at Ulm university heart center between 2014 and 2022. 100 patients were treated with ViV-TAVR. Data regarding device success was available in 2,216 patients treated with TAVR for native valve stenosis. These patients were used to compare device success to patients treated with ViV-TAVR.
Figure 2
Figure 2
In-hospital outcomes of 2,316 patients treated with transcatheter aortic valve replacement (N = 2,216) or valve-in-valve (N = 100) transcatheter aortic valve replacement.
See this image and copyright information in PMC

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