{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:05:17Z","timestamp":1790165117404,"version":"4.1.0"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"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>Aims<\/jats:title>\n                    <jats:p>Following the recent first-in-human experience of Valve in Mechanical Valve (ViMech), interest has emerged in understanding how frequently such an approach might be required in clinical practice. We performed an exploratory meta-analysis to characterize the long-term burden of valve-related complications and reintervention after mechanical aortic valve replacement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Systematic literature search identified studies reporting outcomes of the five most used mechanical aortic valve models (Medtronic\/ATS, St. Jude, Carbomedics, Bicarbon, On-X). Descriptive analysis and random-effects meta-analysis assessed late all-cause and valve-related mortality and complications (bleeding, thromboembolism, valve thrombosis, endocarditis, paravalvular leak, reintervention), expressed per 100 patient-years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty-two studies encompassing 24,960 patients undergoing mechanical valve replacement were assessed. Isolated mechanical aortic valve replacement was reported in all 32 studies (13,890 patients; 98,987 patient-years; mean follow-up 7.1 years); mean age at implantation was 57.9 years (95% CI 56.3\u201359.6) and 43% (38\u201349) were female. Pooled all-cause mortality was 2.39 per 100 patient-years (95% CI 1.92\u20132.99) and valve-related mortality was 0.55 (0.41\u20130.73) per 100 patient-years. Bleeding (0.22 [0.16\u20130.30]) and thromboembolic events (0.18 [0.12\u20130.25]) were the leading causes of valve-related death. Thromboembolic events (0.94 [0.77\u20131.14]) and bleeding (0.85 [0.65\u20131.10]) were the most frequent non-fatal complications, considerably more common than reintervention (0.36 [0.28\u20130.48] per 100 patient-years). All-cause mortality and complication rates were broadly similar across valve models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Mechanical aortic valves show excellent long-term durability with low reintervention rates. Nevertheless, valve-related complications, mainly bleeding and thromboembolism, suggest a small but clinically relevant population in whom redo surgery may carry substantial risk, providing epidemiological context for emerging Valve in Mechanical Valve strategies.<\/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\/CRD420251002419<\/jats:ext-link>\n                      , identifier CRD420251002419.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1920900","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:44:54Z","timestamp":1790163894000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Expanding indications for transcatheter aortic valve implantation: time for valve-in-valve in mechanical prosthesis? A systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Julio","family":"Ruiz-Ruiz","sequence":"first","affiliation":[{"name":"Cardiology Department, University Clinic Hospital of Valladolid","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akash","family":"Jain","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Clinic Hospital of Valladolid","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Garc\u00eda G\u00f3mez","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Clinic Hospital of Valladolid","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Stepanenko","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Clinic Hospital of 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