Redo‐Transcatheter Aortic Valve Implantation Versus Surgical Explantation in Patients With Previous Transcatheter Aortic Valve Implantation: A Systematic Review and Meta‐Analysis

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Background As transcatheter aortic valve implantation (TAVI) expands to younger and lower‐risk populations, failed transcatheter heart valves are increasingly encountered, yet the optimal reintervention strategy remains uncertain. This meta‐analysis aimed to compare the outcomes of redo‐TAVI (TAVI‐in‐TAVI) versus surgical transcatheter heart valve explantation with surgical aortic valve replacement (TAVI‐explantation) after transcatheter heart valve failure. Methods PubMed/Medline, Scopus and Cochrane Central Register of Controlled Trials were systematically searched from inception to September 10, 2025 for comparative studies. The primary outcome was all‐cause mortality (in‐hospital, 30‐day, and 1‐year). Secondary outcomes included cerebrovascular events, major adverse cardiac events, permanent pacemaker implantation, greater‐than‐mild paravalvular leak, major bleeding, length of stay, and 30‐day readmission. As the primary analysis, reconstructed individual patient‐level data were analyzed using Firth penalized logistic regression adjusting for study, and complementary random‐effects meta‐analyses were also used. Results Eight observational studies including 6166 patients (3743 redo‐TAVI; 2425 TAVI‐explantation) were analyzed. Compared with TAVI‐explantation, redo‐TAVI was associated with lower in‐hospital mortality (odds ratio [OR], 0.20 [95% CI, 0.11–0.35]; P <0.0001), 30‐day mortality (OR, 0.28 [95% CI, 0.23–0.34]; P <0.0001), and 1‐year mortality (OR, 0.70 [95% CI, 0.62–0.80]; P <0.0001). No significant differences were observed in cerebrovascular events or permanent pacemaker implantation rates. Redo‐TAVI was associated with lower major bleeding (OR, 0.35 [95% CI, 0.24–0.50]; P <0.0001), fewer 30‐day readmissions (OR, 0.53 [95% CI, 0.30–0.92]; P =0.023), and shorter hospitalization (Mean Difference −6.29 days [95% CI, −8.66 to −3.93), but a higher risk of greater‐than‐mild paravalvular leak (OR, 80.12 [95% CI, 11.30–10 153]; P <0.0001). Conclusions Redo‐TAVI was associated with lower early and 1‐year mortality, reduced bleeding, and shorter hospitalization compared with TAVI‐explantation, with similar cerebrovascular event and permanent pacemaker implantation rates but higher paravalvular leak risk. These findings support redo‐TAVI as the preferred reintervention strategy in anatomically suitable patients, whereas randomized trials and longer‐term follow‐up are needed to refine lifetime management strategies after transcatheter heart valve failure.

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