Lifetime Management of Transcatheter Aortic Valve Replacement: A Guide to Decision-Making and Future Reinterventions

Figures

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  Figure 1. Factors affecting decision making regarding TAVR and SAVR.

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  Figure 2. Decision-making framework for selecting between transcatheter and surgical aortic valve replacement strategies. This algorithm integrates patient-specific factors with lifetime management considerations to optimize initial intervention selection. Key decision points include surgical risk assessment, concurrent coronary disease requiring bypass grafting, and projected lifetime reintervention probability. Abbreviations: TAVR (transcatheter aortic valve replacement), SAVR (surgical aortic valve replacement), CABG (coronary artery bypass grafting), LER (lifetime estimated risk). Adapted from Chen et al. with permission [12].

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  Figure 3. Optimal implantation depth recommendations for maintaining the risk plane below critical anatomical structures during index TAVR procedures. The risk plane represents the commissural post height minus deployment depth. Colour coding indicates conduction risk stratification: green denotes safe deployment (<4 mm) with minimal conduction risk; orange suggests moderate risk (4–8 mm) requiring careful monitoring; red indicates high conduction risk or technically unfeasible depths (>8 mm). For moderate and high-risk deployments, procedural feasibility requires valve-to-sinotubular junction clearance > 2 mm and valve-to-coronary distance > 4 mm to preserve future redo-TAVR options. Device abbreviations: S3 (SAPIEN 3), STJ (sinotubular junction), TAVI (transcatheter aortic valve implantation), VTC (valve-to-coronary), VTSTJ (valve-to-STJ), Ultra (SAPIEN Ultra).

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  Figure 4. Currently available transcatheter aortic valve platforms. Adapted from Valvo et al. [37] with permission.