Short-Term Outcomes Following Transcatheter Valve-in-Valve Implantation With Portico or Navitor Valves: The Barts Heart Center Experience.

Background: Degeneration of surgical bioprosthetic aortic valves is increasingly common. Redo surgical aortic valve replacement carries substantial morbidity and mortality, particularly in elderly or high-risk patients. Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) has become an established alternative, though data on the performance of self-expanding Portico and Navitor valves remain limited.

Methods: We retrospectively analyzed 47 consecutive patients who underwent ViV TAVI for severe bioprosthetic aortic valve dysfunction between January 2020 and June 2024 at Barts Heart Center. In-hospital and 30-day outcomes were evaluated using Valve Academic Research Consortium 3 criteria.

Results: The median age was 79 years, and 80.9% had small surgical valves (≤ 23 mm). ViV TAVI with Portico or Navitor valves was successful in 46 cases (97.9%), with no in-hospital mortality or need for emergency cardiac surgery. Technical success was achieved in 89.4% of cases; failures were related to two major vascular complications, two valve-related interventions, and one major cardiac structural complication. At 30 days, device success and safety outcomes were favorable, with no deaths or additional major complications. Two patients (4.3%) experienced ischemic stroke, and one (2.8%) required a new permanent pacemaker. Most patients (97.8%) were in NYHA class I-II. Echocardiography confirmed intended valve performance in 87% of cases, with no moderate or severe aortic regurgitation.

Conclusions: ViV TAVI with Portico and Navitor valves is a safe and effective option for failed surgical bioprostheses, including small valves, offering excellent short-term outcomes. Further studies are needed to assess long-term durability.