Redo TAVR with balloon-expandable valves linked to positive outcomes, key improvements
Redo transcatheter aortic valve replacement (TAVR) procedures with balloon-expandable valves are both safe and effective, according to new real-world data published in EuroIntervention.[1]
“TAVR indications have rapidly expanded to include intermediate- and low-risk patients, extending its use to younger individuals with longer life expectancies,” wrote first author Giuseppe Tarantini, MD, PhD, an interventional cardiologist with the University of Padua in Italy, and colleagues. “While this evolution increases procedural volumes, it simultaneously raises concerns regarding the long-term durability of transcatheter heart valves (THVs), all of which are bioprosthetic and prone to structural valve deterioration. Consequently, the need for reintervention after TAVI is expected to rise substantially. Surgical explantation of failed THVs remains an option but is technically demanding and associated with increased morbidity and mortality. Redo TAVR, implanting a second THV within the failed one, offers a less invasive alternative and is poised to become the predominant therapeutic strategy in this clinical setting.”
Hoping to secure more real-world evidence on redo TAVR, Tarantini et al. explored data from 143 patients who underwent redo TAVR from 2023 to 2025. The mean age was 84 years old and median Society of Thoracic Surgeons risk score was 7%. More than 40% of patients were women.
All patients received a balloon-expandable Sapien 3, Sapien 3 Ultra or Sapien 3 Ultra Resilia THV from Edwards Lifesciences. Failing THVs included devices made by Edwards Lifesciences, Medtronic and Boston Scientific.
Overall, replacement valves were successfully implanted in 95.1% of patients and the 30-day mortality rate was 3.5%. The 30-day stroke and permanent pacemaker rates, meanwhile, were, 0.7% and 6.4%, respectively.
In addition, redo TAVR was linked to consistent improvements in mean gradient and a significant reduction in stenotic failures. Coronary obstruction was seen in 1.4% of patients.
The authors described these data as “reassuring.”
“These outcomes were achieved through individualized procedural strategies, careful valve sizing, and meticulous implantation techniques,” they wrote. “A distinctive feature of this registry is the use of a procedural guidance document, combined with access to a central case review board. Given the technical complexity of redo TAVR and the value of collaborative, case-specific planning, this approach was frequently utilized by participating centers.”
Tarantini and colleagues added that they plan on following these data and eventually sharing long-term outcomes.
“If the results of this procedure are maintained at the longer-term follow-up, transcatheter therapy will be reinforced as the preferred initial strategy in the lifetime management of younger patients with aortic stenosis,” they wrote.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.