Redo Transcatheter Aortic Valve Replacement: Device Selection and Risks

Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for patients with severe aortic valve stenosis or regurgitation, especially those at intermediate-to-high surgical risk. As TAVR indications expand, the patient population is progressively younger, increasing the likelihood of bioprosthetic valve failure (BVF) over time. This shift highlights the need for effective long-term management strategies. This review focuses on the evolving role of redo-TAVR, specifically the TAV-in-TAV approach, for managing BVF. Key challenges include coronary obstruction, valve migration and device selection. Preprocedural planning, particularly through advanced imaging techniques, such as CT, is critical if complications are to be minimised. This review discusses important technical considerations for TAV-in-TAV procedures, including valve sizing, implantation depth and the impact of valve design on coronary access. A multidisciplinary heart team is essential for assessing patient anatomy and appropriate device selection. Although outcomes appear promising, further research is required to refine procedural techniques and optimise long-term results for patients undergoing redo-TAVR.