Outcomes of Redo Transcatheter Aortic Valve Replacement: A Systematic Review and Pooled Analysis

Background As transcatheter aortic valve replacement (TAVR) expands to younger and lower-risk populations, the incidence of transcatheter valve failure requiring reintervention is expected to increase. Redo-TAVR has emerged as a potential strategy for managing failed transcatheter valves, offering a less invasive alternative to surgical explantation. However, the safety and clinical outcomes associated with redo-TAVR remain incompletely defined. This study aimed to evaluate the procedural outcomes, clinical complications, and available hemodynamic data following redo-TAVR. Methods A systematic review of the literature was conducted to identify studies reporting outcomes of redo-TAVR for failed transcatheter aortic valves. Data were extracted on early mortality, stroke, major bleeding, pacemaker implantation, reintervention, and hemodynamic outcomes. Weighted pooled estimates were calculated where appropriate using reported study sample sizes. Results Thirty-day or in-hospital mortality averaged 2.7% (range 0%-11%), while mortality during available follow-up was approximately 14.7% across heterogeneous follow-up durations (1-3 years). Stroke occurred in approximately 3.7%, major bleeding in 10.1%, new permanent pacemaker implantation in 9.5%, and repeat intervention after redo-TAVR in 1.4% of patients. Reported postprocedural mean transvalvular gradients were generally low across studies, although heterogeneity in follow-up duration precluded meaningful pooled analysis of longer-term hemodynamic outcomes. Conclusion Contemporary evidence suggests that, over available follow-up periods, redo-TAVR is a safe and effective treatment strategy for selected patients with failed transcatheter aortic valves, with low early mortality and acceptable rates of major complications. As the population of patients living with prior TAVR continues to grow, redo-TAVR is likely to play an increasingly important role in lifetime valve management. Further prospective studies with standardized reporting and longer follow-up are required to better define long-term durability and valve-specific outcomes.