目的 比较经导管瓣中瓣置换术（ViV-TAVR）与二次外科主动脉瓣置换术（redo-SAVR）在生物瓣膜衰败患者中的应用效果及安全性。 方法 回顾性收集2020年1月至2022年6月医院收治的61例接受ViV-TAVR或redo-SAVR治疗的生物瓣膜衰败患者临床资料。根据治疗方案不同分为ViV-TAVR组（n = 31）与redo-SAVR组（n = 30）。比较两组围术期相关指标（手术时间、住院时间、机械通气时间、重症监护室观察时间），术前（T₁）、术后1个月（T₂）、术后3个月（T₃）、术后6个月（T₄）超声心动图指标，主要终点事件与次要终点事件。 结果 ViV-TAVR组手术时间、住院时间较redo-SAVR组更短，体外循环辅助较redo-SAVR组更少，差异有统计学意义（P < 0.05）。组内比较显示，术后1个月（T₂）、术后3个月（T₃）、术后6个月（T₄）时点两组左心室射血分数（LVEF）、主动脉瓣峰值流速（AVmax）、峰值跨瓣压差（PGmax）、PGmean均低于术前（T₁）时点，T3、T4时点两组左心室舒张末期内径（LVEDD）均低于T₁、T₂时点，差异有统计学意义（P < 0.05）。ViV-TAVR组30 d内死亡率低于redo-SAVR组，差异有统计学意义（P < 0.05）；两组24个月内的全因死亡率比较，差异无统计学意义（P > 0.05）。ViV-TAVR组急性肾衰竭发生率低于redo-SAVR组，差异有统计学意义（P < 0.05）。 结论 相较于redo-SAVR，ViV-TAVR能有效降低生物瓣膜衰败患者30 d内的死亡风险以及急性肾衰竭的发生风险，但其远期死亡率与redo-SAVR相当。

Objective Compare the efficacy and safety of Transcatheter Aortic Valve Replacement （ViV TAVR） versus Secondary Surgical Aortic Valve Replacement （redo SAVR） in patients with structural valve deterioration. Methods A retrospective analysis of clinical data was performed on 61 patients with valve failure who underwent ViV TAVR or redo SAVR treatment at the hospital between January 2020 and June 2022. Based on the differing treatment modalities， the patients were categorized into two groups： the ViV TAVR group （n = 31） and the redo SAVR group （n = 30）. The study compared perioperative-related indicators （surgical time， hospital stay duration， mechanical ventilation time， and intensive care unit observation period）， echocardiographic parameters at four time points： preoperatively （T₁）， 1 month postoperatively （T₂）， 3 months postoperatively （T₃）， and 6 months postoperatively （T₄）， as well as primary and secondary endpoint events. Results The ViV-TAVR group had shorter operation time and hospital stay， and less extracorporeal circulation assistance compared to the redo-SAVR group， with statistically significant differences （P < 0.05）. Intra-group comparisons showed that at 1 month （T2）， 3 months （T₃）， and 6 months （T₄） after surgery， the left ventricular ejection fraction （LVEF）， aortic valve peak flow velocity （AVmax）， peak transvalvular pressure gradient （PGmax）， and PGmean in both groups were lower than those at the preoperative （T₁） time point. At T₃ and T₄， the left ventricular end-diastolic diameter （LVEDD） in both groups was lower than that at T₁ and T₂， with statistically significant differences （P < 0.05）. The mortality rate within 30 days in the ViV-TAVR group was lower than that in the redo-SAVR group， with a statistically significant difference （P < 0.05）. However， there was no statistically significant difference in all-cause mortality within 24 months between the two groups （P > 0.05）. The incidence of acute renal failure in the ViV-TAVR group was lower than that in the redo-SAVR group， with a statistically significant difference （P < 0.05）. Conclusion Compared with redo SAVR， ViV TAVR not only significantly decreases the 30-day mortality risk and the incidence of acute renal failure in patients with bioprosthetic valve dysfunction but also demonstrates comparable long-term mortality rates to redo SAVR.