Managing Transcatheter Aortic Valve Failure

As transcatheter aortic valve replacement (TAVR) expands rapidly into younger low-risk cohorts with long life expectancy, increasing numbers of patients will outlive their valves and present with bioprosthetic valve failure requiring treatment. Age, comorbidities, and the complexity of surgical explantation will make redo TAVR the preferred treatment option in the vast majority of patients. However, redo TAVR poses specific anatomical challenges, including an elevated risk of coronary artery obstruction, the preservation of coronary access, and optimization of hemodynamic outcomes and long-term durability, though few data exist to guide clinicians in the optimal procedural approach. Meanwhile, surgical explantation and valve replacement will remain a vital option in specific groups, including those with endocarditis and with anatomical features that prohibit redo TAVR. This review article provides a detailed exposition of the challenges of both transcatheter and surgical treatment of transcatheter aortic valve failure, recommended strategies for diagnosis, preprocedural planning and procedural execution to deliver safe and effective outcomes, and a summary of the current evidence base in this growing field.