Roadmap for Redo Transcatheter Aortic Valve Implantation: Are We There Yet?

Recent clinical trials have demonstrated the noninferiority of transcatheter aortic valve implantation (TAVI) compared with surgical aortic valve replacement (SAVR) in the treatment of patients with severe aortic stenosis at low surgical risk. 1 Elgendy IY Mahmoud AN Gad MM Elbadawi A Rivero F Alfonso F Transcatheter or surgical aortic valve replacement for low surgical risk patients: meta-analysis of randomized trials. JACC Cardiovasc Interv. 2019; 12: 1399-1401 Crossref PubMed Scopus (16) Google Scholar ,2 Members WC Otto CM Nishimura RA Bonow RO Carabello BA Erwin III, JP F Gentile H Jneid EV Krieger M Mack 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. J Am Coll Cardiol. 2021; 77: 450-500 Crossref PubMed Scopus (382) Google Scholar Therefore, TAVI has expanded into younger patients with potentially greater longevity. In many of these patients, structural degeneration of transcatheter heart valves (THVs) will occur over time and repeat intervention may eventually be needed. TAVI has been demonstrated to be a viable option for the management of failed surgical bioprostheses; however, there is a paucity of data regarding the outcomes of TAVI in failed transcatheter bioprostheses (i.e., redo TAVI). Redo TAVI procedures involve complexities related to patient anatomy and variability in THV designs and implantation details. Planning redo TAVI procedures must take into account several considerations, including the mode of failure of index THV, designs of index and redo THV, and patient-specific anatomy, with the goals of low periprocedural risk, optimal hemodynamics, and preservation of coronary access. Currently, the SAPIEN 3 valve is the only valve approved for valve-in-valve procedures in the aortic position. 3 Tarantini G Delgado V de Backer O Sathananthan J Treede H Saia F Blackman D Parma R Redo-Transcatheter Aortic Valve Implantation Using the SAPIEN 3/Ultra Transcatheter Heart Valves—Expert Consensus on Procedural Planning and Techniques. Am J Cardiol. 2023; 192: 228-244 Abstract Full Text Full Text PDF Scopus (1) Google Scholar Given the lack of available data and the complex nature of redo TAVI procedures, societal and expert recommendations are of great value. Redo-Transcatheter Aortic Valve Implantation Using the SAPIEN 3/Ultra Transcatheter Heart Valves—Expert Consensus on Procedural Planning and TechniquesAmerican Journal of CardiologyVol. 192PreviewRecent guidelines on valvular heart disease in Europe and the United States have expanded the indications for transcatheter aortic valve implantation (TAVI) to younger patients and those at lower surgical risk with severe symptomatic aortic stenosis. Consequently, the number of TAVI procedures will significantly increase worldwide. Patients with longer life expectancies will outlive their transcatheter heart valves (THVs) and require established treatment strategies for re-intervention. Current data have shown encouraging outcomes, including low mortality, with redo-TAVI; in contrast, surgical explantation of THVs is associated with high mortality. Full-Text PDF Open Access