Transcatheter Aortic Valve Replacement after Prior David Procedure: A Systematic Review and Meta-analysis

The David and Yacoub procedures, also known as Valve-Sparing Aortic Root Replacement (VSARR) are surgical options for aortic root aneurysms. However, patients may develop severe aortic regurgitation (AR) or stenosis. This study evaluates the efficacy, technical challenges and procedural outcomes of Transcatheter Aortic Valve Replacement (TAVR) after failed VSARR. We included case reports, case series and observational studies published up to March 11, 2025. The target population is adult patients with a history of VSARR. The primary outcome is procedural success. Secondary outcomes included mortality, coronary obstruction, valve migration or embolisation, need for second valve, permanent pacemaker implantation, residual AR ≥ moderate, New York Heart Association classification (NYHA) functional class improvement, reintervention and post-TAVR Mean Gradient. Nine studies with a total of 151 patients were included. The procedural success rate was 100.0%. Thirty-day post procedure and in hospital mortality rates were 0.0%. The incidence of coronary obstruction, valve migration, need for a second valve implantation and the need for permanent pacemaker implantation was 0.0% in each category, no statistical heterogeneity among the studies. The pooled incidence of moderate-to-severe AR was 0.0%. All the patients have experienced an improvement in their functional class according to the NYHA classification. The mean transvalvular pressure gradient was 7.35 mmHg (95% confidence interval: 5.87–8.83 mmHg). TAVR is a reliable and safe management strategy after a failed VSARR. There is a significant improvement in patients’ parameters with minimal complications. Future research with larger cohorts of patients from various centers can confirm these outcomes.