{"id":8763,"date":"2025-09-26T20:12:27","date_gmt":"2025-09-26T17:12:27","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8763"},"modified":"2025-09-26T20:12:46","modified_gmt":"2025-09-26T17:12:46","slug":"8763","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/8763\/","title":{"rendered":"TAVR Reinterventions: Redo vs. Surgical Removal \u2013 Trends and Clinical Insights"},"content":{"rendered":"
TAVR Reinterventions: Redo vs. Surgical Removal \u2013 Trends and Clinical Insights<\/div>\n
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Source: JAMA Cardiology, Sept 24, 2025.<\/div>\n
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1. Levels of Indication<\/div>\n
\u2022 Transcatheter Aortic Valve Replacement (TAVR) expanded significantly after the PARTNER-3 and Evolut Low Risk trials in 2019, which demonstrated safety and efficacy even in low-risk patients.<\/span><\/div>\n
\u2022 However, guidelines do not assign Class I recommendation to TAVR in all low-risk groups:<\/span><\/div>\n
\u2022 ACC\/AHA 2020:<\/span><\/div>\n
\u2022 Class I: TAVR for patients at high surgical risk.<\/span><\/div>\n
\u2022 Age 65\u201380 years: Either TAVR or SAVR is reasonable<\/span><\/div>\n
\u2022 <65 years with long life expectancy: SAVR remains the preferred option.<\/span><\/div>\n
\u2022 ESC\/EACTS 2021:<\/span><\/div>\n
\u2022 Favors TAVI \u226570 years or high-risk patients if transfemoral access is feasible. For <70 years and low risk, SAVR is recommended.<\/span><\/div>\n
\u2022 Bottom line: Since 2019, robust evidence has supported TAVR across risk strata, but TAVR is not a universal Class I option for all low-risk patients.<\/span><\/div>\n
<\/div>\n
2. Study Overview<\/div>\n
\u2022 Data: More than 410,000 patients undergoing TAVR (Jan 2012 \u2013 Jun 2024).<\/span><\/div>\n
\u2022 Overall reintervention rate: 0.91% (redo TAVR or surgical removal).<\/span><\/div>\n
\u2022 Breakdown:<\/span><\/div>\n
\u2022 Redo TAVR (valve-in-valve): 63.8%<\/span><\/div>\n
\u2022 Surgical removal with SAVR (open heart surgery): 36.2%<\/span><\/div>\n
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3. Clinical Characteristics<\/div>\n
\u2022 Redo TAVR patients: 86.8% had heart failure.<\/span><\/div>\n
\u2022 Surgical removal group:<\/span><\/div>\n
\u2022 16.1% underwent CABG.<\/span><\/div>\n
\u2022 25% had concomitant mitral valve surgery.<\/span><\/div>\n
\u2022 14.9% had thoracic aortic surgery.<\/span><\/div>\n
\u2022 Timing: Most redo TAVRs occurred within \u22643 months of the index procedure, suggesting early technical failure (e.g., paravalvular leak, prosthesis\u2013patient mismatch).<\/span><\/div>\n
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4. Trends Over Time<\/div>\n
\u2022 TAVR reinterventions: Increased from 0.17% in 2019 \u2192 0.28% in 2023.<\/span><\/div>\n
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Findings in the surgical valve replacement (SAVR) cohort (~300,000 patients):<\/div>\n
\u2022 After (SAVR), 1.68% of patients later received a TAVR inside the surgical valve (valve-in-valve TAVR).<\/span><\/div>\n
\u2022 1.4% of patients required a second surgical valve replacement (redo SAVR).<\/span><\/div>\n
\u2022 The overall rate of reinterventions after SAVR increased over time: from 0.24% in 2014 to 0.73% in 2023.<\/span><\/div>\n
\u2022 This increase was driven mainly by the growing use of valve-in-valve TAVR, while redo SAVR procedures have declined.<\/span><\/div>\n
\u2022 Redo SAVR is declining; the increase is entirely driven by valve-in-valve TAVR.<\/span><\/div>\n
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5. Redo TAVR vs. Surgical Removal<\/div>\n
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Redo TAVR (Valve-in-Valve procedure)<\/div>\n
\u2022 Definition: Valve-in-Valve TAVR = implanting a new transcatheter valve inside a previously implanted valve (surgical or transcatheter), not the native valve.<\/span><\/div>\n
\u2022 Indication: Valve-in-Valve TAVR is indicated for degenerated bioprosthetic valves; mechanical valves are not suitable for this procedure.<\/span><\/div>\n
\u2022 Advantages:<\/span><\/div>\n
\u2022 Less invasive, lower perioperative risk.<\/span><\/div>\n
\u2022 Shorter recovery; often preferred in elderly or high-risk patients.<\/span><\/div>\n
\u2022 Limitations:<\/span><\/div>\n
\u2022 Higher residual gradients if the prior valve was small.<\/span><\/div>\n
\u2022 Not feasible in the presence of infection or unfavorable anatomy.<\/span><\/div>\n
<\/div>\n
Surgical Removal with SAVR (open heart surgery)<\/div>\n
\u2022 Indications:<\/span><\/div>\n
\u2022 Prosthetic valve infection (endocarditis).<\/span><\/div>\n
\u2022 Severe calcification or degeneration preventing stable anchoring of a new valve.<\/span><\/div>\n
\u2022 Anatomical limitations (e.g., high risk of coronary obstruction, device malposition).<\/span><\/div>\n
\u2022 Major complications (device migration, aortic root injury).<\/span><\/div>\n
\u2022 Limitations:<\/span><\/div>\n
\u2022 More technically complex, associated with higher operative risk.<\/span><\/div>\n
\u2022 Requires advanced surgical expertise and specialized centers.<\/span><\/div>\n
<\/div>\n
6. Clinical Message<\/div>\n
\u2022 Redo TAVR should be the preferred reintervention when technically feasible, particularly in elderly or high-risk patients.<\/span><\/div>\n
\u2022 Surgical removal with SAVR is required when valve infection, anatomic limitations, or severe degeneration make redo TAVR unsafe.<\/span><\/div>\n
\u2022 Reinterventions remain rare (<1%) but are increasing as younger, lower-risk patients undergo TAVR.<\/span><\/div>\n
\u2022 Highlights the importance of lifetime management strategies for aortic stenosis, with careful Heart Team decision-making at the index procedure.<\/span><\/div>\n
<\/div>\n
7. Key Takeaways<\/div>\n
1. TAVR has strong trial evidence across risk levels, but is not Class I for all low-risk patients.<\/span><\/div>\n
2. Overall reintervention rate remains low (0.91%) but is increasing with broader TAVR use.<\/span><\/div>\n
3. Redo TAVR is usually favored: less invasive, safer in most cases.<\/span><\/div>\n
4. Surgical removal with SAVR is necessary in cases of infection, anatomical challenges, or major complications.<\/span><\/div>\n
5. Personalized Heart Team planning is critical to optimize long-term outcomes and durability strategies.<\/span><\/div>\n
<\/div>\n
\u00a0https:\/\/jamanetwork.com\/journals\/jamacardiology\/fullarticle\/2839154<\/a><\/div>\n
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<\/div>\n","protected":false},"excerpt":{"rendered":"

TAVR Reinterventions: Redo vs. Surgical Removal \u2013 Trends and Clinical Insights Source: JAMA Cardiology, Sept 24, 2025. 1. Levels of Indication \u2022 Transcatheter Aortic Valve Replacement (TAVR) expanded significantly after the PARTNER-3 and Evolut Low Risk trials in 2019, which demonstrated safety and efficacy even in low-risk patients. \u2022 However, guidelines do not assign Class […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8763","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8763","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=8763"}],"version-history":[{"count":2,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8763\/revisions"}],"predecessor-version":[{"id":8765,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8763\/revisions\/8765"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8763"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8763"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8763"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}