When redo-transcatheter aortic valve replacement (TAVR) is not enough: self-expanding TAVR explant and the next frontier of lifetime valve management

Abstract

a practical, rather than theoretical, issue (3). Reintervention after TAVR remains uncommon on a per-patient basis, yet the absolute number is rising: in the FRANCE 2 and FRANCE TAVI registries, cumulative reintervention reached 1.7% at 8 years, and in a recent Centers for Medicare & Medicaid Services (CMS) analysis of more than 410,000 TAVR patients, both redo-TAVR and TAVR explant volumes continued to increase, with redo-TAVR predominating beyond 5 years after the index procedure (4,5). The central question is therefore no longer whether failed TAVR will be encountered, but whether the initial procedure and every subsequent valve or coronary intervention preserve a safe exit strategy when failure occurs (6). That is where this case becomes especially instructive. Redo-TAVR is an excellent therapy in the right patient, but it is only as good as the anatomy it inherits. In