Valve-in-Valve TAVR Versus Redo Surgery in Women With Degenerated Aortic Bioprosthesis: A Single-Center Experience.

BACKGROUND: Bioprosthetic aortic valves require reinterventions once they degenerate. Options include redo-surgical aortic valve replacement (redoSAVR) and Valve-in-Valve transcatheter aortic valve replacement (ViV). Women with valvular disease have historically demonstrated higher procedural risks and worse outcomes compared to men. There is a knowledge gap regarding outcomes of aortic valve reinterventions in women.

AIMS: We sought to compare outcomes of ViV versus redoSAVR in women with degenerated bioprosthetic surgical valves.

METHODS: Consecutive female patients with prior SAVR undergoing isolated ViV or redoSAVR between 2015 and 2025 were included. Primary endpoints were 30-day all-cause mortality, stroke, and major adverse cardiac events (MACE). Secondary (1-year) endpoints included mortality, stroke, MACE, pacemaker implantation, and cardiac rehospitalization. Propensity score matching (PSM), Cox regression for survival, and Kaplan-Meier for MACE were performed.

RESULTS: Forty redoSAVR and 92 ViV female patients were included. ViV females were older, had lower BMI, and higher STS-PROM. Primary endpoints were not significantly different between ViV and redoSAVR: mortality 1 (1.1%) versus 1 (2.5%), p = 0.303; stroke 3 (3.3%) versus 2 (5.0%), p = 0.480; MACE 3 (3.3%) versus 3 (7.5%), p = 0.272. 1-year endpoints were also comparable: mortality 8 (8.7%) versus 3 (7.5%), p = 0.867; stroke 4 (4.3%) versus 2 (5.0%), p = 0.834; MACE 11 (12.0%) versus 5 (12.5%), p = 0.888; pacemaker 3 (3.3%) versus 1 (2.5%), p = 0.792; rehospitalization 10 (10.9%) versus 2 (5.0%), p = 0.265). Results were consistent before and after PSM.

CONCLUSIONS: ViV and redoSAVR in women yielded similar short-term outcomes. Both represent valid options for treatment of degenerated aortic bioprosthesis.