Redo transcatheter aortic valve replacement in degenerated transcatheter bioprosthesis (TAV-in-TAV)

ABSTRACT

Introduction

With the expanding indications of transcatheter aortic valve replacement (TAVR) to younger and low-risk patients, the life expectancy of patients currently undergoing TAVR will likely outlive the durability of transcatheter bioprosthesis. Consequently, the number of failed transcatheter bioprosthesis requiring surgical valve explant or redo TAVR is expected to increase.

Areas covered

The aim of this review is to provide an updated overview of redo TAVR for treating degenerated transcatheter bioprosthesis, focusing on pre-procedural planning, potential challenges of coronary reaccess during TAVR-in-TAVR and main outcomes of TAVR explant and redo TAVR.

Expert opinion

Patient-tailored device selection and individualized implantation height should be carefully assessed during the index TAVR procedure (weighting between pacemaker avoidance and the potential risk of coronary occlusion in future TAVR-in-TAVR). Future prospective studies comparing safety and clinical outcomes between redo TAVR vs TAVR explant are eagerly awaited.

KEYWORDS:

• Aortic stenosis
• surgical aortic valve
• transcatheter aortic valve replacement
• redo TAVR
• coronary access

Article highlights

• The incidence of failed transcatheter bioprosthesis is increasing over time.

• Reintervention for failed TAVR includes surgical explant or repeat TAVR. Both techniques have proven to be feasible, but surgery can be technically challenging and associated with significant mortality.

• Comprehensive pre-procedural computed tomography assessment is paramount to assess the feasibility of redo TAVR, sizing, implantation technique, and anticipate potential risk for coronary obstruction.

Declaration of interest

L Asmarats is proctor for Abbott and has received lecture fees from Edwards Lifesciences. X Millán, CH Li and D Arzamendi are proctors for Abbott. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.