Redo-Transcatheter Aortic Valve Replacement: Current Evidence and Procedural Considerations

Transcatheter aortic valve replacement (TAVR) has revolutionized the management of severe aortic stenosis (AS), with indications expanding from high and intermediate- to low-surgical risk patients. However, the durability of transcatheter heart valves (THV) is still an ongoing concern, especially in younger, low-risk patients. Redo-TAVR (TAVR-in-TAVR) is feasible and is associated with favorable short-term outcomes in observational studies and registries. Understanding native aortic valve (AV) anatomy and the characteristics of the index THV is critical to the technical and procedural success of redo-TAVR. Cardiac computed tomography angiography (CTA) plays a central role in pre-procedure planning and aids in appropriate valve selection and procedural planning in addition to identifying patients at high risk for coronary occlusion during redo-TAVR. While evidence on redo-TAVR is limited to retrospective observational studies, prospective registries will shed light on the long-term clinical and hemodynamic outcomes.