Redo aortic valve replacement versus valve-in-valve trans-catheter aortic valve implantation: a UK propensity-matched analysis

This study sought to compare the morbidity and mortality ofredo aortic valve replacement (redo-AVR) versus valve-in-valvetrans-catheter aortic valve implantation (valve-in-valve TAVI) forpatients with a failing bioprosthetic valve.A multicenter UK ret-rospective study of redo-AVR or valve-in-valve TAVI for patientsreferred for redo aortic valve intervention due to a degeneratedaortic bioprosthesis. Propensity score matching was performed forconfounding factors.From July 2005 to April 2021, 911 patientsunderwent redo-AVR and 411 patients underwent valve-in-valveTAVI. There were 125 pairs for analysis after propensity scorematching. The mean age was 75.2±8.5 years. In-hospital mortalitywas 7.2% (n=9) for redo-AVR versus 0 for valve-in-valve TAVI, p=0.002. Surgical patients suffered more post-operative complica-tions, including intra-aortic balloon pump support (p=0.02), earlyre-operation (p<0.001), arrhythmias (p<0.001), respiratory andneurological complications (p=0.02 and p=0.03) and multi-organfailure (p=0.01). The valve-in-valve TAVI group had a shorterintensive care unit and hospital stay (p<0.001 for both). However,moderate aortic regurgitation at discharge and higher post-proce-dural gradients were more common after valve-in-valve TAVI(p<0.001 for both). Survival probabilities in patients who weresuccessfully discharged from the hospital were similar after valve-in-valve TAVI and redo-AVR over the 6-year follow-up (log-rankp=0.26). In elderly patients with a degenerated aortic bioprosthe-sis, valve-in-valve TAVI provides better early outcomes asopposed to redo-AVR, although there was no difference in mid-term survival in patients successfully discharged from the hospital.