Retrospective studies have provided information on valve system comparisons in the field of valve-in-valve transcatheter aortic valve replacement (ViV-TAVR). For a study, researchers sought to compare the hemodynamic outcomes of the self-expanding valve (SEV) Evolut (R/PRO/PRO+, Medtronic) with the balloon-expandable valve (BEV) SAPIEN (3/ULTRA, Edwards Lifesciences) during ViV-TAVR.

The recipients of failed small surgical valves (≤23 mm) were randomly assigned to either a BEV or a SEV. The main outcome was the Doppler echocardiography-detected valve hemodynamics at 30 days (maximal/mean residual gradients, severe prosthesis patient mismatch [PPM], or moderate-severe aortic regurgitation).

A total of 102 patients were randomized, and of them, 98 patients (BEV: n= 46, SEV: n=52) ultimately received a ViV-TAVR operation. There were no variations in clinical outcomes between groups at 30 days following the surgery, which was effective in every patient (no death or stroke events). Patients in the SEV group had lower mean and maximum transvalvular gradient values (15±8 mm Hg vs. 23±8 mm Hg; P<0.001; 28±16 mm Hg vs. 40± 13 mm Hg, P<0.001), as well as a propensity for less severe PPM (44% vs. 64%; P=0.07). No cases of moderate-severe aortic regurgitation were reported. Invasive valve hemodynamic examination was performed on 55 consecutive patients (SEV: n=27; BEV: n=28), and there were no changes in the mean or peak transvalvular gradients between the two groups (P=0.41 and P=0.70, respectively).

ViV-TAVR with a SEV was related to better valve hemodynamics as measured by echocardiography in patients with tiny failed aortic bioprostheses. Intraprocedural invasive valve hemodynamics and 30-day clinical outcomes did not differ between groups.

Reference: jacc.org/doi/10.1016/j.jacc.2022.05.005