Both supra-annular and intra-annular self-expanding valves provide favorable and similar hemodynamic and clinical outcomes following valve-in-valve transcatheter aortic valve replacement.
Key Findings
Methods
Supra-annular self-expanding valves (SASEV) were used far more frequently than intra-annular self-expanding valves (IASEV) in the Australian ViV-TAVR registry.
Total of 683 patients underwent ViV-TAVR in the ACOR (Australian Cardiovascular Outcomes Registry).
566 patients (82.9%) received SASEV and 117 patients (17.1%) received IASEV.
Baseline demographics were similar between groups.
IASEV group had higher rates of heart failure and higher rates of baseline bioprosthetic valve regurgitation at baseline.
Results
Post-procedure mean aortic gradients were comparable between SASEV and IASEV groups and did not reach statistical significance.
Mean gradient was 14.9 mm Hg for SASEV vs 13.3 mm Hg for IASEV (P = 0.070).
Peak atrioventricular velocities were 2.5 m/s for SASEV vs 2.4 m/s for IASEV (P = 0.073).
The Dimensionless Performance Index (DPI) was statistically different between SASEV and IASEV groups post-procedure.
DPI was 0.4 for SASEV vs 0.5 for IASEV (P < 0.001).
A higher DPI in the IASEV group indicates relatively better valve performance by this measure.
Despite statistical significance, overall echocardiographic findings were described as 'similar in both groups.'
Results
At 12 months, there was a numerical but non-statistically significant trend toward higher major adverse cardiac and cerebrovascular events (MACCE) in the IASEV group.
MACCE rates were 11.9% for IASEV vs 7.1% for SASEV (P = 0.129).
MACCE was defined according to Valve Academic Research Consortium (VARC) criteria.
The difference did not reach statistical significance.
Results
Stroke rates at 12 months were numerically higher in the IASEV group compared to the SASEV group, approaching but not reaching statistical significance.
Stroke rates were 5.4% for IASEV vs 1.7% for SASEV (P = 0.058).
This trend toward higher stroke in IASEV did not achieve statistical significance.
No significant differences were observed between groups in mortality or bleeding outcomes.
Results
The findings of comparable outcomes between SASEV and IASEV were consistent after statistical adjustment for confounding variables.
Propensity score adjustment was performed to account for baseline differences between groups.
Multivariable logistic regression was also applied.
Findings were described as 'consistent after propensity score adjustment and multivariable logistic regression.'
What This Means
This research suggests that two types of self-expanding valves used in a procedure called valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) — where a new valve is implanted inside a previously failing surgical valve — produce broadly similar results for patients. The study examined real-world data from 683 patients in an Australian registry, comparing supra-annular self-expanding valves (which open above the valve ring) to intra-annular self-expanding valves (which open within the valve ring). The vast majority of patients received the supra-annular type (83%), while about 17% received the intra-annular type. After the procedure, both groups showed similar valve function as measured by blood flow pressure gradients and valve velocities on echocardiography.
At one year follow-up, both groups had comparable rates of serious complications, death, and bleeding. While there were numerical trends suggesting slightly higher rates of major adverse cardiac and cerebrovascular events (about 12% vs 7%) and stroke (about 5% vs 2%) in the intra-annular group, these differences did not reach statistical significance, meaning they could have occurred by chance given the sample sizes involved. These trends remained non-significant even after the researchers used statistical methods to account for the fact that the two groups were not perfectly matched at baseline — for instance, the intra-annular group had more patients with heart failure at the start.
This research matters because it provides some of the first comparative data between these two self-expanding valve types in this specific setting, using a national outcomes registry. The results suggest that both valve types are reasonable options for ViV-TAVR, though the non-significant trends toward more strokes and adverse events with the intra-annular valve warrant attention in future, larger studies that may be better powered to detect real differences if they exist.
Singh K, Dababneh E, Matta M, Niranjan S, Sinhal A, Jones M, et al.. (2026). Outcomes of Supra-Annular vs Intra-Annular Self-Expanding Valves in Valve-In-Valve Transcatheter Aortic Valve Replacement.. JACC. Cardiovascular interventions. https://doi.org/10.1016/j.jcin.2026.06.022