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Updated: Sep 15, 2025
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Comparison of Latest Generation Intra- and Supra-Annular Self-Expanding Transcatheter Heart Valves for Aortic
Antonia Katharina Stötzel1, Oliver D Bhadra1, Lara Waldschmidt2
1Departments of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Hospital Hamburg Eppendorf, Hamburg, Germany.
Background:
Valve-in-valve (ViV) procedures are an established therapy. Self-expanding (SE) supra-annular transcatheter heart valves (THV) achieve superior hemodynamics compared to balloon-expandable (BE) intra-annular THV, but influence of stent design versus valve position remains unclear.
Aims:
This study compares SE intra- and supra-annular THV for aortic ViV procedures to further elucidate this topic.
Methods:
From 05/2022 to 11/2023, 10 patients underwent ViV procedures with the SE intra-annular Navitor valve. A control group of 22 patients treated with the SE supra-annular Evolut R/PRO valve during the same period was retrieved from our database. Data were retrospectively analyzed according to updated valve academic research consortium (VARC) 3 definitions. A subgroup analysis matched patients for true internal diameter (ID) and body mass index (BMI).
Results:
Postprocedural transvalvular gradients were similar between groups. No differences in rates of significant paravalvular leakage (PVL) were seen (p = 0.131). No all-cause mortality occurred in either group. Device success (study group, Navitor: 70 [7] vs. control group, Evolut: 90.1 [20]; p = 0.293), early safety (90 [9] vs. 86.4 [19]; p = 1.000), permanent pacemaker implantation (PPI) (0 [0] vs. 9.1 [2]; p = 1.000), and stroke (0 [0] vs. 4.5 [1]; p = 1.000) were similar between groups. Procedure time was shorter for the study group (65.8 ± 27.9 min vs. 145.7 ± 51.3 min; p < 0.001). After matching for True ID and BMI these results persisted.
Conclusion:
Intra- and supra-annular THV showed similar clinical and hemodynamic outcomes in aortic ViV procedures. These findings highlight the applicability of SE intra-annular THV for aortic ViV procedures.
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