Transcatheter Valve-in-Valve Replacement With Balloon- Versus Self-Expanding Valves in Patients With Degenerated Stentless Aortic Bioprosthesis.

Valve-in-Valve (ViV) Transcatheter aortic valve replacement (TAVR) has been associated with favorable outcomes in patients with degenerated stentless bioprosthesis. However, whether the outcomes after ViV TAVR for failed stentless bioprosthesis differ between balloon-expandable valves (BEV) and self-expanding valves (SEV) remains unknown. Therefore, we retrospectively analyzed 59 consecutive patients who underwent ViV TAVR for failed stentless bioprsothesis with BEV (N= 42) versus SEV (N= 17) in a single-healthcare system between 2013 and 2022. Overall, mean age was 70.8 years and 74.6% were males. Mean transcatheter valve size was 26.3 ±2.2 mm for BEV and 26.4 ±4 mm for SEV (p= 0.93). Mean STS score was 6.0 ±3.6 for BEV and 7.5 ±5.5 for SEV (p= 0.22). Compared with patients who received BEV, those who received SEV had higher rates of device malposition (2.4% vs. 23.5%; p< 0.01), post-deployment balloon dilation (11.9% vs. 35.5%; p= 0.04) and need for a second transcatheter device (2.4% vs. 35.5%; p< 0.01). However, both groups showed similar improvement in aortic valve function at 30-day and 1-year follow-up (incidence of 1-year severe patient-prosthesis mismatch in BEV: 17.6% vs. 14.3% in SEV; p= 0.78). One-year and 3-year mortality did not differ between BEV and SEV (11.9% vs. 11.8% and 25% vs. 30%; respectively; Log rank p= 0.9). In conclusion, performing ViV TAVR for failed stentless bioprsothesis is technically challenging, especially when using SEV, but satisfactory positioning is possible in most cases, with excellent hemodynamic and clinical outcomes with both BEV and SEV.