Clinical considerations and challenges in TAV-in-TAV procedures

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Transcatheter aortic valve replacement (TAVR) is a common treatment for aortic valve disease, even in low-risk patients.
• Increasing TAVR use raises concerns about long-term valve durability and the need for re-intervention.
• Transcatheter aortic valve (TAV)-in-TAV procedures are emerging as a less morbid alternative to explantation for failed TAVR devices.

Purpose of the Study:

• To comprehensively review the current experience and available data on TAV-in-TAV procedures.
• To discuss essential pre-procedural planning considerations for TAV-in-TAV.
• To highlight challenges, emphasize coronary obstruction assessment, and provide future insights into TAV-in-TAV.

Main Methods:

• Systematic review of existing literature and registry data on TAV-in-TAV procedures.
• Analysis of pre-procedural imaging and planning strategies.
• Evaluation of procedural outcomes, complications, and long-term durability.

Main Results:

• TAV-in-TAV procedures have demonstrated feasibility and promising outcomes in selected patient populations.
• Effective pre-procedural planning, including detailed imaging, is crucial for successful TAV-in-TAV.
• Coronary artery obstruction is a key challenge requiring careful assessment and management strategies.

Conclusions:

• TAV-in-TAV represents a valuable option for managing failed TAVR, potentially avoiding more complex surgical explantation.
• Further research and standardization of techniques are needed to optimize TAV-in-TAV outcomes.
• The technique holds significant potential for the future management of degenerated TAVR valves.