The following is a summary of “Long-term Outcomes of Valve-in-Valve Transcatheter Aortic Valve Implantation Versus Redo Surgical Aortic Valve Replacement: Meta-Analysis of  Kaplan-Meier-derived Data,” published in the December 2023 issue of Cardiology by Sá et al.

The use of Valve-in-Valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as an alternative strategy for patients with bioprosthetic valve failure, offering an alternative to redo surgical aortic valve replacement (SAVR). This meta-analysis aimed to assess all-cause mortality between ViV-TAVI and redo SAVR by analyzing reconstructed time-to-event data from Kaplan-Meier curves in non-randomized studies available up to August 2023. Sixteen eligible studies comprising a total of 4,373 patients (2,204 undergoing ViV-TAVI and 2,169 undergoing redo SAVR) were included. Combining the data from all studies, ViV-TAVI demonstrated a lower risk of all-cause mortality within the initial 6 months [hazard ratio (HR) 0.58, 95% CI 0.46–0.73, P<0.001]. However, beyond this period, the hazard ratio was reversed in favor of redo SAVR (HR 1.92; 95% CI 1.58–2.33; P<0.001). Upon analyzing only matched populations (comprising 64.6% of the overall participants), ViV-TAVI revealed reduced mortality risk within the first 6 months (HR 0.56, 95% CI 0.43–0.73, P<0.001). Nevertheless, beyond this timeframe, a shift in favor of redo SAVR was observed (HR 1.55; 95% CI 1.25–1.93; P<0.001). 

Meta-regression analyses highlighted the impact of various factors such as age, coronary artery disease (CAD), history of coronary artery bypass graft (CABG) surgery, and implanted valve size (<25mm) on these outcomes. In summary, ViV-TAVI demonstrates an initial survival advantage over redo SAVR, but this benefit diminishes over time, with redo SAVR showing improved survival in later stages. It is crucial to interpret these findings cautiously, given their derivation from observational studies, and further randomized controlled trials are warranted for more definitive conclusions.

Source: sciencedirect.com/science/article/abs/pii/S0002914923013462