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.