(C-236) Comparative Postoperative Outcomes and Utilization Trends of Transcatheter Aortic Valve Implantation vs. Redo Surgical Aortic Valve Replacement

Background: Bioprosthetic aortic valve failure necessitates reintervention, with redo surgical aortic valve replacement (redo SAVR) associated with high perioperative risks. Valve-in-valve transcatheter aortic valve implantation (ViV TAVI) provides a less invasive alternative, but real-world evidence comparing outcomes across age subgroups remains limited.

Objectives: To compare postoperative outcomes and analyze utilization trends of ViV TAVI versus redo SAVR in patients with failed aortic bioprostheses, with a focus on the 65–80 age group.

Methods: This retrospective cohort study utilized the Nationwide Readmission Database (NRD) to identify patients aged ≥18 years who underwent ViV TAVI or redo SAVR from 2010 to 2021. Propensity score matching (PSM) was performed to balance covariates. Logistic and Cox regression models estimated odds ratios (OR) and hazard ratios (HR) with 95% confidence intervals (CI).
Primary outcomes: in-hospital mortality and all-cause readmission.
Secondary outcomes: stroke, major adverse cardiac events (MACE), major bleeding, days alive and out of hospital at 30 days and 6 months, and mortality during readmission.
Age-subgroup analyses (65–80, 65–69, 70–74, 75–80) used identical methodology.

Results: Among 12,764 patients, ViV TAVI was associated with:

Lower in-hospital mortality (1.95% vs. 3.80%; OR 0.49, 95% CI 0.33–0.71, p < 0.001).
Reduced major bleeding (36.2% vs. 72.1%; OR 0.22, 95% CI 0.19–0.25, p < 0.001).
Higher pacemaker implantation rates (10.4% vs. 8.4%; OR 1.30, 95% CI 1.06–1.59, p = 0.011).
Higher all-cause readmission rates at 30 days (8.6% vs. 6.2%; HR 1.36, 95% CI 1.09–1.70, p = 0.007) and 6 months (19.5% vs. 15.9%; HR 1.22, 95% CI 1.02–1.47, p = 0.030).
Lower 6-month MACE incidence (4.6% vs. 7.2%; HR 0.64, 95% CI 0.46–0.90, p = 0.009).
ViV TAVI utilization increased annually by 7.3% (p < 0.001), with a trend toward younger patient selection.
In the 65–80 age subgroup, ViV TAVI was associated with significantly lower in-hospital mortality and 6-month MACE. The 75–80 age group showed the greatest benefit.

Conclusions: ViV TAVI utilization has steadily increased, with expanding adoption among younger patients. In the 65–80 age group, ViV TAVI was associated with improved in-hospital and short-term outcomes, particularly in patients aged 75–80. These findings provide real-world evidence supporting ViV TAVI as a preferred reintervention strategy for bioprosthetic valve failure.