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Feasibility of Valve in Valve After Transcatheter Aortic Valve Replacement With SAPIEN 3 Valves and Surgical Aortic

Tej Sheth1, Warkaa Al-Shamkani1, Ahmed Makhdoum1

  • 1Division of Cardiology, McMaster University and Hamilton Health Sciences, Hamilton, Canada.

Structural Heart : the Journal of the Heart Team
|January 7, 2026
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) with SAPIEN 3 at ≤90% implant depth offers the most repeatable intervention for future TAVR. Surgical aortic valve replacement with aortic root enlargement does not improve future TAVR feasibility.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Lifetime management of aortic stenosis requires assessing transcatheter intervention feasibility post-aortic valve replacement.
  • Both transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are primary treatments for aortic stenosis.

Purpose of the Study:

  • To evaluate the feasibility of future transcatheter aortic valve replacement (TAVR) after initial TAVR and surgical aortic valve replacement (SAVR) procedures.
  • To compare the impact of different implant depths for SAPIEN 3 TAVR and the role of aortic root enlargement (ARE) in SAVR on future TAVR access.

Main Methods:

  • A multicenter study analyzed post-treatment computed tomography (CT) scans from 245 patients.
  • Patients were grouped by initial intervention: TAVR (SAPIEN 3, ≤90% depth), TAVR (>90% depth), SAVR, and SAVR with ARE.
  • Future TAVR feasibility was assessed by simulating neo-skirt position relative to coronary ostia and sinotubular junction on CT.

Main Results:

  • The proportion of patients with the simulated neo-skirt below both coronary arteries was highest in TAVR at ≤90% implant depth (47.0%).
  • Challenging anatomy for future TAVR was identified in 9.8% of TAVR (≤90% depth), 28.8% of TAVR (>90% depth), 22.6% of SAVR, and 29.0% of SAVR with ARE.
  • Surgical aortic valve replacement with aortic root enlargement showed 0% favorable anatomy for future TAVR.

Conclusions:

  • Transcatheter aortic valve replacement (TAVR) with SAPIEN 3 at an implant depth of ≤90% provides the most favorable anatomy for subsequent TAVR.
  • Surgical aortic valve replacement with aortic root enlargement does not enhance the feasibility of future transcatheter interventions.
Abstract

Keywords:
Computer tomographySurgical aortic valve replacementTranscatheter aortic valve replacement

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