Clinical and Hemodynamic Outcomes of Redo Transcatheter Aortic Valve Replacement: Insights from Contemporary Practice

Authors

David Rayan, Advocate Health - MidwestFollow
M Fuad Jan, Advocate Health - MidwestFollow
Suhail Allaqaband, Advocate Health - MidwestFollow
Prabhjot Hundal, Advocate Health - MidwestFollow
Kirsten Tunink, Advocate Health - MidwestFollow
Viviana Zlochiver, Advocate Health - MidwestFollow
John Crouch, Advocate Health - MidwestFollow
David Boulware, Advocate Health - MidwestFollow
Renuka Jain, Advocate Health - MidwestFollow
Tanvir Bajwa, Advocate Health - MidwestFollow

Recommended Citation

Rayan D, Jan MF, Allaqaband S, et al. Clinical and Hemodynamic Outcomes of Redo Transcatheter Aortic Valve Replacement: Insights from Contemporary Practice. Abstract at SCAI; April 24, 2026; Montreal, Canada.

Abstract

Background: Following US Food and Drug Administration approval of transcatheter aortic valve replacement (TAVR) for low-risk patients in 2019, TAVR surpassed surgical aortic valve replacement (SAVR) as the predominant treatment for severe aortic stenosis (AS). Both SAVR and TAVR are subject to structural valve degeneration years after implantation, and the number of required valve reinterventions is expected to increase. While outcomes of TAVR-in-SAVR are well described, data on redo TAVR for structural and nonstructural valve degeneration remain limited. We report the largest single-center experience of redo TAVR to date.

Methods: In this retrospective, single-center observational study of patients who underwent redo TAVR between January 1, 2012, and October 25, 2025, 75 patients were identified, including those with prior SAVR followed by TAVR and subsequent redo TAVR (valve-in-valve-in-valve [ViViV]). Indications included degenerative severe AS (n=27, 36%), degenerative severe aortic regurgitation (n=26, 34%), severe paravalvular regurgitation (n=10, 13.3%), and mixed AS and regurgitation (n=12, 16%). Various combinations of balloon-expandable and self-expanding valves were used. Elective, urgent, and emergent cases were included.

Results: The primary endpoint of technical success was achieved in 94.7% of cases. Three patients required procedural modification due to low deployment or valve embolization, all in the setting of prior SAVR (ViViV). All-cause mortality rates at 30 days and 1 year were 2.7% (95% CI 0.7, 10.4) and 16.9% (95% CI 9.3, 29.7), respectively. Major bleeding, stroke, and ventricular laceration occurred in 3 patients. Echocardiographic follow-up demonstrated appropriate valve function with mild or less paravalvular leak in all but 1 patient. At a median follow-up of 491 days, the mean aortic valve gradient was 12.8 mmHg, median aortic valve area was 2.1 cm², and median peak velocity was 2.35 m/s.

Conclusions: Redo TAVR using balloon-expandable and self-expanding valves demonstrates high technical success and favorable mid-term outcomes for both structural and nonstructural valve degeneration, supporting its feasibility as a reintervention strategy.

Type

Oral/Podium Presentation