Key result
Redo TAVR for degenerated transcatheter bioprostheses requires careful pre-procedural planning and individualized device selection during the index procedure to mitigate future risks.
Why the study?
With TAVR indications expanding to younger and low-risk patients, patient life expectancy will likely outlive bioprosthesis durability, increasing the number of failed bioprostheses requiring surgical explant or redo TAVR.
Answers are grounded in this paper and cite their sources.
Careful pre-procedural planning during the index TAVR, including device selection and implantation height, is crucial to mitigate risks like coronary occlusion during future TAV-in-TAV procedures.
INTRODUCTION: With the expanding indications of transcatheter aortic valve replacement (TAVR) to younger and low-risk patients, the life expectancy of patients currently undergoing TAVR will likely outlive the durability of transcatheter bioprosthesis. Consequently, the number of failed transcatheter bioprosthesis requiring surgical valve explant or redo TAVR is expected to increase. AREAS COVERED: The aim of this review is to provide an updated overview of redo TAVR for treating degenerated transcatheter bioprosthesis, focusing on pre-procedural planning, potential challenges of coronary reaccess during TAVR-in-TAVR and main outcomes of TAVR explant and redo TAVR. EXPERT OPINION: Patient-tailored device selection and individualized implantation height should be carefully assessed during the index TAVR procedure (weighting between pacemaker avoidance and the potential risk of coronary occlusion in future TAVR-in-TAVR). Future prospective studies comparing safety and clinical outcomes between redo TAVR vs TAVR explant are eagerly awaited.
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Sánchez-Ceña et al. (2023) conducted a review in Degenerated transcatheter bioprosthesis. Redo transcatheter aortic valve replacement (TAV-in-TAV) was evaluated. Redo TAVR for degenerated transcatheter bioprostheses requires careful pre-procedural planning and individualized device selection during the index procedure to mitigate future risks.
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