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Review
. 2024 Feb 19:11:1334871.
doi: 10.3389/fcvm.2024.1334871. eCollection 2024.

Clinical considerations and challenges in TAV-in-TAV procedures

Ahmad Hayek  1   2 , Cyril Prieur  2 , Nicolas Dürrleman  1 , Quentin Chatelain  1 , Reda Ibrahim  1 , Anita Asgar  1 , Thomas Modine  3 , Walid Ben Ali  1
Affiliations
Review

Clinical considerations and challenges in TAV-in-TAV procedures

Ahmad Hayek et al. Front Cardiovasc Med. .

Abstract

Transcatheter aortic valve replacement (TAVR) has emerged as a viable treatment for aortic valve disease, including low-risk patients. However, as TAVR usage increases, concerns about long-term durability and the potential for addition interventions have arisen. Transcatheter aortic valve (TAV)-in-TAV procedures have shown promise in selected patients in numerous registries, offering a less morbid alternative to TAVR explantation. In this review, the authors aimed to comprehensively review the experience surrounding TAV-in-TAV, summarize available data, discuss pre-procedural planning, highlight associated challenges, emphasize the importance of coronary obstruction assessment and provide insights into the future of this technique.

Keywords: CT planning; TAV-in-TAV; TAVR; coronary obstruction; structural valve deterioration.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Available THV types and characteristics. *Commissural alignment will be available for Sapien X4. BEV, balloon-expandable valve; MEV, mechanically-expandable valve; SEV, self-expandable valve.
Figure 2
Figure 2
Positioning scenarios and considerations in TAV-in-TAV (A) Sapien index THV (B) Corevalve index THV.
Figure 3
Figure 3
Coronary risk assessment before TAV-in-TAV (for Sapien and Corevalve as index THVs). RP, risk plane; VTA, valve to aorta.
Figure 4
Figure 4
Schematic representation of the criteria to determine the risk of coronary flow compromise before TAV-in-TAV in an index Sapien or Corevalve THV. STJ, sino-tubular junction; VTC, valve to coronary; VTSTJ, valve to sino-tubular junction.
Figure 5
Figure 5
Treatment algorithm of patients with TAV failure. BVF, bioprosthetic valve failure; SVD, structural valve deterioration; TAV, transcatheter aortic valve; THV, transcatheter heart valve.
See this image and copyright information in PMC

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