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Hot off the press Happy to share our paper: ”ViV-TAVR vs Redo-SAVR“ in @JACCJournals #JACCINT. Nice collaboration with @JefVandenEynde, @msimonatomd, @LCavalcantiMD, @DoulamisIlias, @KonstantinZhig2, @PolydorosK, @ruhparwar, @AWeymannMD, @PPibarot, @ClavelLabo and others! 1/8
ViV-TAVR is associated with lower rates of 30-day mortality, stroke, permanent pacemaker implantation and major bleeding, BUT... higher rates of myocardial infarction and severe prosthesis-patient mismatch (PPM) in comparison with Redo-SAVR https://www.sciencedirect.com/science/article/abs/pii/S1936879820321075
Biggest problem for ViV-TAVR seems to be PPM. Highly unlikely, if index SAVR with large prostheses. For lifetime management, we might discuss aortic annulus enlargement in index SAVR, aiming larger prostheses (
25mm; obviously, ONLY when needed: small aortic annulus) 
This would enable us to use more ViV-TAVR in the future, when patients most need it or are less willing to undergo surgery (when they’re older/fragile, for example). This would require more EXPERTISE in aortic root enlargement, which has been a subject of heated discussions
Outcomes for reoperation are significantly worse than those for primary surgery. ViV-TAVR would make valve reoperations 
frequent. Good for our patients, isn’t it?
But... Where are the RCTs??? Any chance of carrying out a study for the scenario “ViV-TAVR vs RedoSAVR”???
TAVR + severe PPM = NOT negligible... Already 
mortality rates after 1 year... Annulus enlargement in index SAVR would make it possible for ViV-TAVR to be done without post-procedural PPM... Better hemodynamics...
Just a word of caution: a factor that may lead to overestimation of PPM following ViV-TAVR is the pressure recovery phenomenon. It is possible that a substantial proportion of patients classified as severe PPM do NOT exhibit true severe PPM. Why??? Read this paper
Let‘s discuss this further (and please, don‘t start an all-out war, ok???
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