CT planning optimizes initial TAVR valve selection and facilitates future reinterventions, essential for lifetime management in younger patients with severe aortic stenosis.
As TAVR expands to younger patients, lifetime management strategies including CT planning and TAVR-in-TAVR considerations are essential for optimizing long-term outcomes.
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis, evolving from a therapy reserved for inoperable patients to a first-line option across all surgical risk categories. As TAVR expands to younger patients with longer life expectancies, lifetime management strategies become paramount. This comprehensive review examines the important role of computed tomography (CT) planning in optimizing initial valve selection and predicting future reintervention feasibility. We discuss the decision framework between TAVR and surgical aortic valve replacement (SAVR) as initial therapy, strategies to optimize the index TAVR procedure, including minimizing patient-prosthesis mismatch, reducing paravalvular regurgitation, preventing conduction abnormalities and coronary obstruction, and facilitating future reinterventions. For patients requiring redo procedures, we analyse TAVR-in-TAVR considerations, including risk plane assessment, coronary access preservation, and leaflet modification techniques. Future directions include advances in valve design, artificial intelligence integration in procedural planning, and development of personalized risk assessment tools. Successful lifetime management requires multidisciplinary collaboration and individualized treatment planning to optimize outcomes throughout a patient’s lifetime journey with aortic valve disease.
Lankaputhra et al. (2026) studied this question. CT planning optimizes initial TAVR valve selection and facilitates future reinterventions, essential for lifetime management in younger patients with severe aortic stenosis.