Supplementary file 1_Expanding indications for transcatheter aortic valve implantation: time for valve-in-valve in mechanical prosthesis? A systematic review and meta-analysis.docx

Pooled all-cause mortality was 2.39 per 100 patient-years (95% CI 1.92–2.99) and valve-related mortality was 0.55 (0.41–0.73) per 100 patient-years. Bleeding (0.22 [0.16–0.30]) and thromboembolic events (0.18 [0.12–0.25]) were the leading causes of valve-related death. Thromboembolic events (0.94 [0.77–1.14]) and bleeding (0.85 [0.65–1.10]) were the most frequent non-fatal complications, considerably more common than reintervention (0.36 [0.28–0.48] per 100 patient-years).

All-cause mortality and complication rates were broadly similar across valve models.</p>Conclusions<p>Mechanical aortic valves show excellent long-term durability with low reintervention rates. Nevertheless, valve-related complications, mainly bleeding and thromboembolism, suggest a small but clinically relevant population in whom redo surgery may carry substantial risk, providing epidemiological context for emerging Valve in Mechanical Valve strategies.</p>Systematic Review Registration<p>crd.york.ac.uk/PROSPERO/view/CRD420251002419, identifier CRD420251002419.</p>