Transcatheter vs Surgical Replacement of Degenerated Bioprosthetic Aortic Valve: A Meta-Analysis of Propensity-Score-Matched Studies
In brief
Valve-in-valve TAVR cuts early death risk by about half versus redo surgery
In a meta-analysis of 13 propensity-matched studies (16,200 patients), transcatheter valve-in-valve implantation reduced 30-day mortality by roughly 50% and halved major bleeding and kidney injury, while shortening hospital stays. Mid-term survival, stroke and heart attack rates were similar to redo surgical replacement, but TAVR left higher valve gradients, highlighting the need for careful patient selection and randomized trials.
- Journal
- Heart, lung & circulation (Q2)
- Published
- 9 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Pouya Ebrahimi, Maryam Taheri, Mehrdad Mahalleh, Hamidreza Soleimani, Homa Taheri, Ali Moradi, et al.
- PMID
- 42716866
- DOI
- 10.1016/j.hlc.2026.02.014
Why clinicians should know about it
- Picked for Epidemiology (top studies of the week, 13 September 2026).
Abstract
INTRODUCTION: Degeneration of bioprosthetic aortic valves is a common late complication. While redo surgical aortic valve replacement (redo-SAVR) has traditionally been the standard of care, transcatheter valve-in-valve implantation (ViV-TAVR) has emerged as a less invasive alternative. This meta-analysis aimed to compare outcomes between ViV-TAVR and redo-SAVR using propensity-score-matched studies. METHODS: A systematic search of Cochrane CENTRAL, Scopus, MEDLINE (via PubMed) Embase, and Scopus was conducted from inception through to 1 September 2024. Propensity-score matched cohort studies comparing ViV-TAVR and redo-SAVR were included. Risk ratios (RRs) and mean differences (MDs) or standardised mean differences (SMD), as appropriate, were pooled using a random-effects model. RESULTS: Thirteen propensity score-matched studies encompassing 16,223 patients (8,463 ViV-TAVR; 7,760 redo-SAVR) with a weighted mean follow-up of 16.6 months were included. Compared to redo-SAVR, ViV-TAVR was associated with significantly lower short-term all-cause mortality (RR: 0.47; 95% confidence interval [CI]: 0.34-0.66; p<0.0001), major bleeding (RR: 0.45; 95% CI: 0.33-0.59), acute kidney injury (RR: 0.56; 95% CI: 0.38-0.84), and shorter hospital stay (SMD: -0.79; 95% CI: -1.00 to -0.57). ViV-TAVR was also associated with a significantly lower incidence of new-onset atrial fibrillation (RR: 0.22; 95% CI: 0.13-0.37) but higher post-procedural mean transvalvular gradients (SMD: 0.45; 95% CI: 0.20-0.69). No significant differences were observed in 1- or ≥2-year mortality, stroke/transient ischaemic attack, myocardial infarction, permanent pacemaker implantation, or early readmission. Results remained consistent across sensitivity and subgroup analyses. CONCLUSION: ViV-TAVR offers significant short-term benefits over redo-SAVR, including lower early mortality and shorter hospitalisation. Long-term clinical outcomes remain comparable, while postprocedural mean gradients are higher after ViV-TAVR, underscoring the need for randomised trials and individualised patient selection to guide treatment decisions for degenerated bioprosthetic valves.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.