RESUMO
BACKGROUND Bioprosthetic valves are increasingly implanted in patients with aortic valve stenosis. These valves have a limited durability. Valve-in-valve (ViV) transcatheter aortic valve implanta tion (TAVI) is a treatment option for bioprosthetic valve failure. Both balloon-expandable (BE) and self-expandable (SE) valves are widely used in ViV-TAVI procedures. However, studies comparing outcomes between these fundamentally different valve designs in ViV-TAVI are lacking. METHODS The CENTER study is a patient pooled analysis, comprising data of 12,381 patients undergoing transfemoral TAVI in 6 countries. We assessed differences in clinical outcomes between SE and BE valves in ViV-TAVI patients, as defined by the Valve Academic Research Consortium. RESULTS A total of 256 patients were treated with transfemoral ViV TAVI. Of these, 50% were female, median age was 82 (IQR: 78-85) years, and median STS-PROM was 6.3% (IQR: 4.0%-10.4%). SE valves were used in 162 patients (63%) and BE valves in 94 (37%) patients. SE and BE valve recipients were similar regarding female sex (53% vs 47%; P » 0.38), age (82 years [78-85] vs 81 [78-84]; P » 0.24), and STS PROM (6.5% [4.2%-10.2%] vs 6.2% [4.0%-10.9%]; P » 1.00). Third generation valves were used in 91 (56%) of SE valves and in 40 (43%) of BE valves. There was a trend towards lower 30-day mortality in SE valve patients (3% vs 7%; RR: 0.37; 95% CI: 0.11-1.26; P » 0.10). In addition, 30-day major bleeding was less frequent in SE valve patients (3% vs 13%; RR: 0.27; 95% CI: 0.09-0.79; P » 0.01). Rates of conversion to surgery (1% vs 0; P » 0.44) and device success were similar (90% vs 92%; P » 0.62). Moreover, 30-day rates of stroke (1.9% vs 4.6%; P » 0.22), myocardial infarction (0.7% vs 1.8%; P » 0.46), and permanent pacemaker implantation (9.3% vs 7.9%; P » 0.70) were similar. There was no difference in 1-year mortality (12.5% vs 17.6%; P » 0.32) and stroke rates (3.7% vs 7.4%; P » 0.25). CONCLUSION There was a trend toward lower 30-day mortality in ViV-TAVI patients treated with SE valves. Moreover, the use of SE valves in ViV-TAVI was associated with lower rates of major bleeding than BE valves. Our findings warrant randomized controlled trials directly comparing SE and BE valves in ViV-TAVI patients.