Umbrella Meta-analysis Evaluating the Effectiveness of ViV-TAVI vs Redo SAVR

Since almost a decade, the use of bioprosthetic valves (BPV) has been increasing for the replacement of stenosed aortic valves. With the increasing use, a rise in the BPV failure is noted considering their limited durability. Redo-surgical aortic valve replacement (rSAVR) is by far the only gold standard treatment modality for replacement of deteriorated BPV. Recently, valve in valve-transcatheter aortic valve replacement (ViV-TAVR) is explored as the alternative minimally invasive procedure compared to the gold standard rSAVR. However, its efficacy remains the major concern. Hence, we aimed to conduct the meta-meta-analysis to evaluate the safety and efficacy of ViV-TAVI compared to redo-SAVR. Following PRISMA guidelines, we searched for a meta-analysis comparing the safety and efficacy of ViV-TAVR vs rSAVR from PubMed and included 9 analyses which compared the two modalities head-to-head in terms of outcomes and complications. We included various complications and outcomes like 30-day mortality, long-term mortality, procedural mortality, hospital readmission, and complications including acute MI, stroke, major bleeding, vascular complications, acute kidney injury, and new pacemaker implantation. We carried out a meta-meta-analysis by obtaining pooled odds ratio, 95% CI using random effect models. We found out that there was a significantly low risk of 30-day mortality (pooled OR:0.60; 95%CI:0.53–0.68; p < 0.00001) with no heterogeneity (p = 0.53; I2 = 0%) with ViV-TAVR vs rSAVR. Also, there was a reduced risk of procedural mortality (pooled OR:0.52; 95%CI:0.27–0.98; p = 0.04) with 0% heterogeneity with ViV-TAVR vs rSAVR. ViV-TAVI is associated with significantly reduced risk of 30-day mortality compared to rSAVR. Our meta-meta-analysis reinforces the safety and efficacy of ViV-TAVR as the procedure of choice for failed bioprosthetic (BP) valves in high-risk candidates.