Objective This study aimed to assess short-term outcomes of patients with failed aortic valve bioprosthesis undergoing valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) or redo surgical aortic valve replacement (rSAVR).

Methods Between 2009 and 2019, 90 patients who underwent ViV-TAVR (n = 73) or rSAVR (n = 17) due to failed aortic valve bioprosthesis fulfilled the inclusion criteria. Groups were compared regarding clinical end points, including in-hospital all-cause mortality. Patients with endocarditis and in a need of combined cardiac surgery were excluded from the study.

Results ViV-TAVR patients were older (78.0 ± 7.4 vs. 62.1 ± 16.2 years, p = 0.012) and showed a higher prevalence of baseline comorbidities such as atrial fibrillation, diabetes mellitus, hyperlipidemia, and arterial hypertension. In-hospital all-cause mortality was higher for rSAVR than in the ViV-TAVR group (17.6 vs. 0%, p < 0.001), whereas intensive care unit stay was more often complicated by blood transfusions for rSAVR patients without differences in cerebrovascular events. The paravalvular leak was detected in 52.1% ViV-TAVR patients compared with 0% among rSAVR patients (p < 0.001).

Conclusion ViV-TAVR can be a safe and feasible alternative treatment option in patients with degenerated aortic valve bioprosthesis. The choice of treatment should include the patient's individual characteristics considering ViV-TAVR as a standard of care.

目的 本研究旨在评估接受瓣中瓣经导管主动脉瓣置换术 (ViV-TAVR) 或再次手术主动脉瓣置换术 (rSAVR) 失败的主动脉瓣生物瓣膜患者的短期结果。

方法2009 年至 2019 年，90 例 因主动脉瓣生物瓣膜失败而 接受 ViV-TAVR（n  = 73）或 rSAVR（n = 17）的患者符合纳入标准。比较各组的临床终点，包括院内全因死亡率。患有心内膜炎和需要联合心脏手术的患者被排除在研究之外。

结果 ViV-TAVR 患者年龄较大（78.0 ± 7.4 vs. 62.1 ± 16.2 岁，p  = 0.012），基线合并症如心房颤动、糖尿病、高脂血症和动脉高血压的患病率较高。rSAVR 的院内全因死亡率高于 ViV-TAVR 组（17.6 对 0%，p  < 0.001），而 rSAVR 患者在重症监护病房的住院时间更常因输血而复杂化，脑血管事件无差异. 52.1% 的 ViV-TAVR 患者检测到瓣周漏，而 rSAVR 患者为 0%（p  < 0.001）。

结论 ViV-TAVR 是退变主动脉瓣生物瓣膜患者安全可行的替代治疗选择。治疗的选择应包括考虑 ViV-TAVR 作为护理标准的患者的个体特征。