Latest-iteration self-expanding vs balloon-expandable transcatheter heart valves for failed surgical bioprostheses The INNOVATE registry

Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is increasingly performed in degenerated surgical bioprostheses, although data concerning the performance of latest iterations of transcatheter heart valves (THVs) are scarce.

We aimed to compare procedural, clinical and haemodynamic outcomes of latest-generation THVs in ViV TAVI.

This multicenter retrospective study included 381 consecutive patients undergoing ViV TAVI, 294 with self-expanding (SE), and 87 with a balloon expandable (BE) THV. Primary efficacy endpoints were Valve Academic Research Consortium (VARC)-3 technical and device success. Primary safety outcomes were all-cause death and re-hospitalization for heart failure (HF). Patients receiving SE valves were older (79 vs 75 years, P < .001). Time from surgery to ViV was longer in BE group (4 vs 3 years, P = .041). A numerically higher rate of coronary obstruction (4% vs 0%, P = .076) was observed in SE THVs, despite a more frequent coronary protection (24% vs 14%, P = .045). Technical (95% vs 98%, P = .380) and device success (89% vs 79%, P = .105) were similar. At 1 year, SE valves showed significantly lower mean gradients (14 ± 8 vs 21 ± 8 mmHg, P < .001). Rates of paravalvular leak and patient–prosthesis mismatch did not differ between groups. All-cause mortality (5% vs 4%, P = .928) and re-hospitalization for HF (4% vs 2%, P = .507) was also comparable among SE and BE, likewise myocardial infarction, stroke, and permanent pacemaker implantation.

Latest iterations of SE and BE THVs provided favourable outcomes in ViV TAVI, without significant differences in safety/efficacy profile. SE platforms achieved lower residual gradients at 1 year.