{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:08:32Z","timestamp":1789711712663,"version":"4.0.1"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>With the expanding use of transcatheter aortic valve replacement (TAVR) in younger patients, the need for reintervention on failed bioprostheses is rising. Comparative evidence between redo TAVR for failed transcatheter valves (TAV-in-TAV) and TAVR for failed surgical valves (TAV-in-SAV) is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To systematically review and meta-analyse the clinical, haemodynamic, and safety outcomes of TAV-in-TAV versus TAV-in-SAV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Scopus, Web of Science, Cochrane CENTRAL, and Embase were searched from inception to April 2026. Studies directly comparing TAV-in-TAV with TAV-in-SAV and reporting original data with \u226510 patients per group were included. Risk of bias was assessed using ROBINS-I and the Newcastle-Ottawa Scale. Random-effects meta-analyses were performed for 30-day mortality, 1-year mortality, mean transvalvular gradient at 30 days, and new permanent pacemaker (PPM) implantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four observational studies, including 705 patients in the extracted comparative cohorts, met the inclusion criteria. Two full-text studies contributed to the primary quantitative analyses. TAV-in-TAV was not associated with a statistically significant difference in 30-day mortality compared with TAV-in-SAV (OR 0.71, 95% CI 0.25\u20132.00), nor in 1-year mortality (OR 1.02, 95% CI 0.47\u20132.18). TAV-in-TAV was associated with lower mean transvalvular gradients at 30 days (MD \u22122.71 mmHg, 95% CI \u22124.07 to \u22121.34). A non-significant trend toward higher new permanent pacemaker implantation was observed after TAV-in-TAV (OR 1.85, 95% CI 0.94\u20133.65).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Current comparative evidence between TAV-in-TAV and TAV-in-SAV remains limited and observational. No definitive mortality difference was identified, but clinically meaningful benefit or harm cannot be excluded. TAV-in-TAV shows a consistent early haemodynamic signal with lower gradients, while the possible increase in pacemaker implantation remains exploratory. These findings should be considered hypothesis-generating and require confirmation in larger prospective studies with longer follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261369410<\/jats:ext-link>\n                      , PROSPERO CRD420261369410.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1870804","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:36:15Z","timestamp":1789709775000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Transcatheter aortic valve replacement in failed transcatheter versus failed surgical bioprostheses: a systematic review with exploratory meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Mohammad","family":"Ghannam","sequence":"first","affiliation":[{"name":"Brookdale University Hospital and Medical Center","place":["Brooklyn, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Abomohsen","sequence":"additional","affiliation":[{"name":"Brookdale University Hospital and Medical Center","place":["Brooklyn, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iyad Y.","family":"Idries","sequence":"additional","affiliation":[{"name":"Brookdale University Hospital and Medical Center","place":["Brooklyn, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fayez","family":"Shamoon","sequence":"additional","affiliation":[{"name":"St. Joseph\u2019s University Medical Center","place":["Paterson, NJ, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Ghallab","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Creighton University","place":["Omaha, NE, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fawzi","family":"Zghyer","sequence":"additional","affiliation":[{"name":"Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation","place":["Cleveland, OH, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alena V.","family":"Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Failure Division, University of Alabama at Birmingham","place":["Birmingham, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Ahmad","sequence":"additional","affiliation":[{"name":"St. Joseph\u2019s University Medical Center","place":["Paterson, NJ, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habib A.","family":"Habib","sequence":"additional","affiliation":[{"name":"St. Joseph\u2019s University Medical Center","place":["Paterson, NJ, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul","family":"Vasudev","sequence":"additional","affiliation":[{"name":"St. Joseph\u2019s University Medical Center","place":["Paterson, NJ, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.1056\/NEJMoa1814052","article-title":"Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients","volume":"380","author":"Mack","year":"2019","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1706","DOI":"10.1056\/NEJMoa1816885","article-title":"Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients","volume":"380","author":"Popma","year":"2019","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1016\/j.athoracsur.2020.09.002","article-title":"STS-ACC TVT registry of transcatheter aortic valve replacement","volume":"111","author":"Carroll","year":"2021","journal-title":"Ann Thorac Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1016\/j.athoracsur.2014.10.070","article-title":"Long-term durability of bioprosthetic aortic valves: implications from 12,569 implants","volume":"99","author":"Johnston","year":"2015","journal-title":"Ann Thorac Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1016\/j.jacc.2018.10.078","article-title":"Long-term durability of transcatheter aortic valve prostheses","volume":"73","author":"Blackman","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1001\/jama.2014.7246","article-title":"Transcatheter aortic valve implantation in failed bioprosthetic surgical valves","volume":"312","author":"Dvir","year":"2014","journal-title":"JAMA"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2253","DOI":"10.1016\/j.jacc.2017.02.057","article-title":"Transcatheter aortic valve implantation within degenerated aortic surgical bioprostheses: PARTNER 2 valve-in-valve registry","volume":"69","author":"Webb","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1882","DOI":"10.1016\/j.jacc.2020.02.051","article-title":"Repeat transcatheter aortic valve replacement for transcatheter prosthesis dysfunction","volume":"75","author":"Landes","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jacc.2020.10.053","article-title":"Transcatheter replacement of transcatheter versus surgically implanted aortic valve bioprostheses","volume":"77","author":"Landes","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.amjcard.2025.08.052","article-title":"Comparative 3-year outcomes of transcatheter aortic valve replacement in failed transcatheter versus surgical valves","volume":"258","author":"Rosenzveig","year":"2026","journal-title":"Am J Cardiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e013973","DOI":"10.1161\/JAHA.119.013973","article-title":"Valve-in-valve for degenerated transcatheter aortic valve replacement versus valve-in-valve for degenerated surgical aortic bioprostheses: a 3-center comparison of hemodynamic and 1-year outcome","volume":"9","author":"Raschpichler","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"B12","year":""},{"key":"B13","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","author":"Page","year":"2021","journal-title":"Br Med J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst Rev"},{"key":"B15","doi-asserted-by":"publisher","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"Br Med J"},{"key":"B16","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"Br Med J"},{"key":"B17","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/1471-2288-14-135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range","volume":"14","author":"Wan","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1136\/bmj.331.7521.903","article-title":"Standard deviations and standard errors","volume":"331","author":"Altman","year":"2005","journal-title":"Br Med J"},{"key":"B19","article-title":"Cochrane handbook for systematic reviews of interventions version 6.3 (updated February 2022)","volume-title":"Cochrane","author":"Higgins","year":"2022"},{"key":"B20","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.jjcc.2025.06.022","article-title":"Valve in valve transcatheter versus redo surgical replacement of a failing surgical bioprosthetic aortic valve: an updated systematic review and meta-analysis","volume":"86","author":"Dimitriadis","year":"2025","journal-title":"J Cardiol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1037\/0033-2909.99.3.400","article-title":"Meta-analytic procedures for combining studies with multiple effect sizes","volume":"99","author":"Rosenthal","year":"1986","journal-title":"Psychol Bull"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz747.0509","article-title":"P913 What can we expect after valve-in-valve procedures in failed transcatheter aortic valves?","volume":"40","author":"Goppel","year":"2019","journal-title":"Eur Heart J"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1870804\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:36:16Z","timestamp":1789709776000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1870804\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":22,"alternative-id":["10.3389\/fcvm.2026.1870804"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1870804","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]},"article-number":"1870804"}}