Supra‐Annular Versus Intra‐Annular Devices for Transcatheter Aortic Valve‐in‐Valve Replacement: The PANDORA International Registry

BACKGROUND: As transcatheter aortic valve replacement (TAVR) expands to younger, lower-risk populations, the need for repeat procedures due to valve degeneration is expected to increase. TAVR-in-TAVR has emerged as a feasible strategy, although outcomes across supra-annular (SAV) and intra-annular (IAV) valve combinations remain unclear. The PANDORA (Supra-Annular Versus Intra-Annular Devices for TAVR-in-TAVR) international registry study assessed safety, hemodynamic performance, and clinical outcomes of TAVR-in-TAVR according to prosthetic configurations. METHODS: From an international multicenter registry (2011-2024), 172 TAVR-in-TAVR cases were identified among ≈30 000 TAVR procedures, with a median interval of 1401 days. Patients were stratified into 4 groups: SAV-IAV (n=32), SAV-SAV (n=29), IAV-SAV (n=74), and IAV-IAV (n=37). RESULTS: =0.734). Male sex and chronic kidney disease independently predicted death at follow-up. CONCLUSIONS: TAVR-in-TAVR is feasible with generally favorable outcomes, although clinical and procedural profiles vary by the different prosthesis combinations. These findings highlight the need for further studies to refine device selection strategies.

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Journal
Journal of the American Heart Association
Published
2026-04-16
DOI
https://doi.org/10.1161/jaha.125.046180
Primary Topic
Cardiac Valve Diseases and Treatments
Type
article
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article

Supra‐Annular Versus Intra‐Annular Devices for Transcatheter Aortic Valve‐in‐Valve Replacement: The PANDORA International Registry

Matjaž Bunc, Ole De Backer, Andrea Scotti, Ignacio Jesus Amat-Santos et al.
Journal of the American Heart Association
Cardiac Valve Diseases and Treatments
article

Supra‐Annular Versus Intra‐Annular Devices for Transcatheter Aortic Valve‐in‐Valve Replacement: The PANDORA International Registry

Matjaž Bunc, Ole De Backer, Andrea Scotti, Ignacio Jesus Amat-Santos, Christina Brinkmann, Michele Morosato, Luca Testa, Andreas Baumbach, Kush Patel, Antonio Sisinni, Didier Tchétché, Nicolas Van Mieghem, D Hildick-Smith, A Latib, E Criscione, E Poletti, F Bedogni, D Regazzoli, A Popolo Rubbio, Michiel Voskuil, Joachim Schofer, Gaspare S. Cannone
article en

Abstract

BACKGROUND: As transcatheter aortic valve replacement (TAVR) expands to younger, lower-risk populations, the need for repeat procedures due to valve degeneration is expected to increase. TAVR-in-TAVR has emerged as a feasible strategy, although outcomes across supra-annular (SAV) and intra-annular (IAV) valve combinations remain unclear. The PANDORA (Supra-Annular Versus Intra-Annular Devices for TAVR-in-TAVR) international registry study assessed safety, hemodynamic performance, and clinical outcomes of TAVR-in-TAVR according to prosthetic configurations. METHODS: From an international multicenter registry (2011-2024), 172 TAVR-in-TAVR cases were identified among ≈30 000 TAVR procedures, with a median interval of 1401 days. Patients were stratified into 4 groups: SAV-IAV (n=32), SAV-SAV (n=29), IAV-SAV (n=74), and IAV-IAV (n=37). RESULTS: =0.734). Male sex and chronic kidney disease independently predicted death at follow-up. CONCLUSIONS: TAVR-in-TAVR is feasible with generally favorable outcomes, although clinical and procedural profiles vary by the different prosthesis combinations. These findings highlight the need for further studies to refine device selection strategies.

Journal of the American Heart AssociationVol. 15(8)
Montefiore Medical Center (US), Humanitas University (IT), Queen Mary University of London (GB), Barts Health NHS Trust (GB), Erasmus MC (NL), Copenhagen University Hospital (DK), Rigshospitalet (DK), University Medical Center (US), Centro de Investigación en Red en Enfermedades Cardiovasculares (ES), IRCCS Policlinico San Donato (IT), University Hospital and Clinics (US), Centro de Investigación Biomédica en Red (ES), Asklepios Klinik St. Georg (DE), Clinique Pasteur (FR), University Hospitals Sussex NHS Foundation Trust (GB), IRCCS Humanitas Research Hospital (IT)
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Cardiac Valve Diseases and Treatments
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