Key result
Repeat transcatheter aortic valve replacement (TAVR-in-TAVR) requires careful pre-procedural CT planning to assess coronary occlusion risk, as future coronary access may be difficult or impossible.
Why the study?
With TAVR expanding to younger, lower-risk patients with longer life expectancy, transcatheter heart valve durability has become central and an increase in TAVR-in-TAVR procedures is expected.
TAVR-in-TAVR requires careful pre-procedural planning with cardiac CT to assess coronary occlusion risk, and initial TAVR choices should consider future TAVR-in-TAVR feasibility.
Alerts clinicians to rising TAVR-in-TAVR demand in younger patients; leaves open standardized safety and durability benchmarks.
Introduction: Transcatheter aortic valve replacement (TAVR) has recently expanded toward the treatment of younger patients with lower surgical risk and longer life expectancy. Thus, transcatheter heart valve (THV) durability has become a central issue, and an important increase in the number of TAVR-in-TAVR is expected in the coming years.Areas covered: Overview of the current status of TAVR-in-TAVR for the treatment of THV dysfunction, focusing on safety and efficacy of repeat TAVR procedures.Expert opinion: An accurate analysis of the pre-procedure cardiac computed tomography, incorporating new parameters such as the position of the top of the first THV in relation to the sinotubular-junction, will be necessary to assess the risk of coronary occlusion. Subsequent coronary angiography will be necessary in a proportion of TAVR-in-TAVR patients, but coronary access may be very difficult or even impossible in some of them. Therefore, the choice between TAVR and SAVR in young low-risk patients should incorporate the potential need for treating coronary events at mid- to long-term follow-up. Likewise, the choice of the valve type and the implantation position at the time of the first TAVR procedure should take into account the possibility of TAVR-in-TAVR in the future.
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Faroux et al. (2020) conducted a review in Transcatheter prosthesis dysfunction. Repeat transcatheter aortic valve replacement (TAVR-in-TAVR) was evaluated. Repeat transcatheter aortic valve replacement (TAVR-in-TAVR) requires careful pre-procedural CT planning to assess coronary occlusion risk, as future coronary access may be difficult or impossible.
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