Redo-TAVR (TAV-in-TAV) Best Practices Part 2: Tall-in-Short and Tall-in-Tall

Q: What is the clinical evidence from this study?

Study design: Review. Population: Structural valve deterioration following transcatheter aortic valve replacement (TAVR). Intervention: Redo-TAVR using tall-frame self-expanding valves (tall-in-short and tall-in-tall).

Vinayak Bapat; Syed Zaid; Miho Fukui; Steven Joseph Yakubov; P Yadunandan Yadav; Mathew R. Williams; John G. Webb; Nicolas M. Van Mieghem; Didier Tchétché; Giuseppe Tarantini; Ana Paula Tagliari; Curtiss Stinis; Cezar S. Staniloae; Stephanie Sellers; Toby Rogers; Grant William Reed; Basel Ramlawi; K. Poon; Radosław Parma; Yohei Ohno; Kamran Muhammad; Thomas Modine; David J. Meier; Raj Makkar; Uri Landes; Simon C.C. Lam; Yusuke Kobari; Sahil Khera; Jaffar M. Khan; Tsuyoshi Kaneko; Kentaro Hayashida; Juan F. Granada; Sachin S. Goel; Sachin S. Goel; Santiago A. Garcia; Gregory P. Fontana; Jeremiah P. Depta; Augustin Delago; Ole De Backer; Harold L. Dauerman; Lakshmi Prasad Dasi; Michael P. Caskey; Daniel J. Blackman; Ravinay Bhindi; Guilherme Attizzani; Ignacio Jesus Amat-Santos; Keith B. Allen; Mariama Akodad; Mohamed Abdel‐Wahab; Michael J. Mack; Martin B. Leon; Andrei Pop; Gilbert H.L. Tang

doi:10.1016/j.jcin.2026.06.004

June 24, 2026JACC: Cardiovascular InterventionsOpen Access

Redo-TAVR (TAV-in-TAV) Best Practices Part 2: Tall-in-Short and Tall-in-Tall

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Why the study?

Implanting tall-frame self-expanding valves within failed short- or tall-frame transcatheter valves for structural valve deterioration presents distinct challenges related to anchoring, constrained expansion, valve alignment, and the risk of coronary obstruction or sinus sequestration.

Key Points

Establish standardized definitions, preprocedural evaluation protocols, and procedural best practices for redo transcatheter aortic valve replacement using tall-frame self-expanding valves.
International multidisciplinary panel under the Heart and Valve Collaboratory reviewed bench testing and clinical evidence.
Synthesized technical strategies for computed tomography-based sizing, predilatation, deployment, postdilatation, coronary protection, and surgical conversion.
Standardized computed tomography imaging workflows to evaluate anchoring, expansion limits, and risk profiles for coronary obstruction or sinus sequestration from neoskirt planes.
Outlined technical recommendations for valve deployment, coronary artery preservation, leaflet modification techniques, and indications for hybrid surgical approaches.
Provided a structured procedural troubleshooting algorithm to support safe and reproducible execution in tall-in-short and tall-in-tall configurations.

Structured PICO

P

Population

Patients requiring redo-transcatheter aortic valve replacement (TAV-in-TAV) for structural valve deterioration of failed short- or tall-frame transcatheter valves

I

Intervention

Redo-TAVR using tall-frame self-expanding valves implanted within failed short- or tall-frame transcatheter valves ('tall-in-short' and 'tall-in-tall'), including CT-based sizing, predilatation, deployment technique, postdilatation, coronary protection, leaflet modification, or hybrid surgical alternatives

This international consensus document establishes standardized definitions, CT-based sizing strategies, and a pragmatic procedural workflow for performing redo-TAVR using tall-frame self-expanding valves within failed short- or tall-frame transcatheter valves.

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Implication

Warrants immediate adoption of standardized CT workflows in redo-TAVR; extends prior data into Level 1 consensus for valve-in-valve cases.

Abstract

Transcatheter aortic valve replacement (TAVR) has created a growing population of patients who require redo-TAVR (TAV-in-TAV) for structural valve deterioration. Tall-frame self-expanding valves implanted within failed short- or tall-frame transcatheter valves ("tall-in-short" and "tall-in-tall") present distinct challenges related to anchoring, constrained expansion, valve alignment, and the risk for coronary obstruction or sinus sequestration driven by the resulting neoskirt plane. Under the auspices of the Heart and Valve Collaboratory, an international multidisciplinary panel reviewed bench and clinical data and synthesized contemporary best practices into a pragmatic procedural workflow for redo-TAVR in these settings. This consensus document standardizes key definitions, outlines computed tomography-based strategies for in vivo sizing and risk stratification, and details recommended approaches to predilatation, deployment technique, postdilatation, coronary protection and leaflet modification, or hybrid surgical alternative when needed. A structured troubleshooting guide is provided to support safe, reproducible execution and coronary preservation.

Discussion

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Cite This Study

Bapat et al. (2026) conducted a review in Structural valve deterioration following transcatheter aortic valve replacement (TAVR). Redo-TAVR using tall-frame self-expanding valves (tall-in-short and tall-in-tall) was evaluated. Redo-TAVR using tall-frame self-expanding valves in failed short- or tall-frame valves requires standardized CT sizing, deployment, and coronary protection workflows.

synapsesocial.com/papers/6af086d03cd4c3da28a1eb28 https://doi.org/10.1016/j.jcin.2026.06.004

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Redo-TAVR (TAV-in-TAV) Best Practices Part 2: Tall-in-Short and Tall-in-Tall

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Redo-TAVR (TAV-in-TAV) Best Practices Part 2: Tall-in-Short and Tall-in-Tall

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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