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 of redo aortic valve replacement (redo-AVR) versus valve -in -valve trans -catheter aortic valve implantation (valve -in -valve TAVI) for patients with a failing bioprosthetic valve. A multicenter UK retrospective study of redo-AVR or valve-in-valve TAVI for patients referred for redo aortic valve intervention due to a degenerated aortic bioprosthesis. Propensity score matching was performed for confounding factors. From July 2005 to April 2021, 911 patients underwent redo-AVR and 411 patients underwent valve -in -valve TAVI. There were 125 pairs for analysis after propensity score matching. The mean age was 75.2 +/- 8.5 years. In -hospital mortality was 7.2% (n=9) for redo-AVR versus 0 for valve -in -valve TAVI, p=0.002. Surgical patients suffered more post -operative complications, including intra-aortic balloon pump support (p=0.02), early re -operation (p<0.001), arrhythmias (p<0.001), respiratory and neurological complications (p=0.02 and p=0.03) and multi -organ failure (p=0.01). The valve -in -valve TAVI group had a shorter intensive care unit and hospital stay (p<0.001 for both). However, moderate aortic regurgitation at discharge and higher post -procedural gradients were more common after valve-in-valve TAVI (p<0.001 for both). Survival probabilities in patients who were successfully discharged from the hospital were similar after valve in -valve TAVI and redo-AVR over the 6 -year follow-up (log -rank p=0.26). In elderly patients with a degenerated aortic bioprosthesis, valve -in -valve TAVI provides better early outcomes as opposed to redo-AVR, although there was no difference in midterm survival in patients successfully discharged from the hospital.