Reintervention After Transcatheter Aortic Valve Replacement

Assessment of the optimal management in patients requiring reintervention after transcatheter aortic valve replacement (TAVR). Since its inception in 2002, TAVR has significantly transformed the management of aortic stenosis. The treatment for TAVR procedural and device failures varies depending on the specific cause of failure. As the number of TAVR procedures increases, particularly in individuals aged 70 or younger, it is likely that we will see a rise in the number of patients needing further treatment due to degeneration of the transcatheter heart valve. Although TAVR has proved to be safe and effective, structural valve deterioration is inevitable. Even though TAVR has shown promising data of low structural valve deterioration rates up to 6 years from various clinical trials and up to 10 years in isolated series, the majority of these patients were older. But, reintervention after TAVR seems unavoidable. It may need reintervention with a second TAVR valve, or it may require surgical TAVR-explant and subsequent surgical aortic valve replacement. Also, a third option in the form of a hybrid technique, is available now. Thus, the selection of patients is crucial in choosing the appropriate initial management as it can have long-term repercussions.