Why the study?
As TAVR expands to younger patients who may outlive their bioprosthesis, guidance is needed on aortic valve reintervention options, balancing the anatomic risks of redo-TAVR against the high morbidity and mortality of surgical explantation.
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This review outlines the current evidence and challenges in managing transcatheter heart valve failure, comparing redo-TAVR and surgical explantation to guide lifetime management of aortic stenosis.
Transcatheter aortic valve replacement (TAVR) is increasingly being performed in younger and lower surgical risk patients. Reintervention for failed transcatheter heart valves will likely increase in the future as younger patients are expected to outlive the initial bioprosthesis. While redo-TAVR has emerged as an attractive and less invasive alternative to surgical explantation (TAVR-explant) to treat transcatheter heart valve failure, it may not be feasible in all patients due to the risk of coronary obstruction and impaired coronary access. Conversely, TAVR-explant can be offered to most patients who are surgical candidates, but the reported outcomes have shown high mortality and morbidity. This review provides the latest evidence, current challenges, and future directions on redo-TAVR and TAVR-explant for transcatheter heart valve failure, to guide aortic valve reintervention and facilitate patients' lifetime management of aortic stenosis.
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Zaid et al. (2023) studied this question.
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