ArticleClinical research in cardiology : official journal of the German Cardiac Society2026
Treatment selection and long-term survival in patients aged 50 to < 75 years undergoing valve reintervention for failed surgical aortic bioprostheses: insights from the Netherlands Heart Registration.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo describe real-world treatment allocation and observed long-term survival in patients aged 50 to < 75 years with failed surgical aortic bioprostheses who underwent reintervention through valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) or redo surgical aortic valve replacement (redo-SAVR) in the Netherlands.
methodsPatients aged 50 to < 75 years who underwent ViV-TAVI or redo-SAVR for a failing surgical bioprosthesis between 2015 and 2020 were identified from the Netherlands Heart Registration. Baseline characteristics and Dutch surgical-risk categories were compared by treatment strategy. Multivariable logistic regression was used to identify factors associated with ViV-TAVI selection. Kaplan-Meier analysis described survival, and treatment-specific Cox models explored factors associated with all-cause mortality.
resultsOf 345 patients, 41% underwent ViV-TAVI and 59% redo-SAVR. Patients selected for ViV-TAVI were older (median 71 vs. 67 years, p < 0.001), had higher surgical risk (EuroSCORE II: 6.2% vs. 4.6%, p = 0.014), and had a greater comorbidity burden than redo-SAVR patients. Despite these baseline risk differences, estimated survival within the ViV-TAVI cohort was 94.2% at 30 days, 89.6% at 2 years, and 74.4% at 4 years; corresponding redo-SAVR estimates were 96.1%, 89.8%, and 88.4%. Left ventricular ejection fraction ≤ 30% and chronic lung disease were associated both with ViV-TAVI selection (OR: 8.04, 95% CI: 2.16-29.92 and OR: 3.25, 95% CI: 1.53-6.92, respectively) and with all-cause mortality after redo-SAVR (HR: 15.70, 95% CI: 2.49-67.14 and HR: 4.23, 95% CI: 1.53-13.14, respectively).
conclusionIn this Dutch observational registry, ViV-TAVI was predominantly selected for patients with a higher-risk clinical phenotype, while redo-SAVR was more often used in lower-risk reintervention candidates and showed higher observed long-term survival. These data describe contemporary treatment selection and prognosis but do not establish comparative superiority of either strategy.
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