Transcatheter atrioventricular valve-in-valve re-replacement with balloon-expandable prostheses: contemporary clinical relevance and place among redo valve interventions

Abstract

Introduction: The steadily increasing number of patients with structural degeneration of bioprosthetic heart valves necessitates the search for alternatives to redo open surgery, which is associated with high operative risk due to resternotomy, adhesions, repeat cardiopulmonary bypass, and an unfavorable comorbidity profile. In this context, transcatheter valve-in-valve re-replacement has emerged as one of the key management strategies for this patient population, especially in the technically most challenging atrioventricular positions. Objective: To assess the contemporary clinical relevance of transcatheter atrioventricular re-replacement and define its place in the structure of redo interventions based on the clinical case series reported by R.S. Tarasov et al. and current international literature. Results: This article reviews the technical and clinical aspects of mitral and tricuspid re-replacement using balloon-expandable prostheses. Recent meta-analyses have shown that the valve-in-valve technique is non-inferior to surgical re-replacement in terms of survival, while being associated with significantly lower rates of stroke, bleeding, and acute kidney injury. Particular attention is paid to the role of multislice computed tomography in preventing left ventricular outflow tract obstruction during mitral interventions, to the principles of balloon-expandable prosthesis positioning in the atrioventricular position, and to the possibility of minimizing anesthetic support during tricuspid re-replacement. At the same time, the limitations of the current evidence base and several unresolved issues are emphasized, including implanted device durability, the risk of residual gradients, and paravalvular regurgitation. Conclusion: At present, transcatheter valve-in-valve re-replacement in atrioventricular positions should be regarded not merely as an alternative for patients at prohibitive risk, but as a clinically justified component of the contemporary treatment strategy capable of substantially reducing procedural burden and accelerating rehabilitation. Nevertheless, the definitive determination of its role requires prospective studies with long-term outcome assessment. Received 23 June 2026. Revised 24 June 2026. Accepted 24 June 2026. Funding The study did not have sponsorship.