Redo-TAVR (TAV-in-TAV) Best Practices Part 2: Tall-in-Short and Tall-in-Tall

IF 12.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2026-08-24 Epub Date: 2026-06-24 DOI:10.1016/j.jcin.2026.06.004

Vinayak N. Bapat MBBS, Syed Zaid MD, Miho Fukui MD, PhD, Steven J. Yakubov MD, Pradeep Yadav MD, Mathew R. Williams MD, John G. Webb MD, Nicolas Van Mieghem MD, PhD, Didier Tchétché MD, Giuseppe Tarantini MD, PhD, Ana Paula Tagliari MD, PhD, Curtiss T. Stinis MD, Cezar S. Staniloae MD, Stephanie L. Sellers PhD, Toby Rogers MD, PhD, Grant W. Reed MD, Basel Ramlawi MD, Karl Poon MD, Radoslaw Parma MD, PhD, Yohei Ohno MD, PhD, Gilbert H.L. Tang MD, MSc, MBA

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引用次数: 0

Abstract

Transcatheter aortic valve replacement (TAVR) has created a growing population of patients who require redo-TAVR (TAV-in-TAV) for structural valve deterioration. Tall-frame self-expanding valves implanted within failed short- or tall-frame transcatheter valves (“tall-in-short” and “tall-in-tall”) present distinct challenges related to anchoring, constrained expansion, valve alignment, and the risk for coronary obstruction or sinus sequestration driven by the resulting neoskirt plane. Under the auspices of the Heart and Valve Collaboratory, an international multidisciplinary panel reviewed bench and clinical data and synthesized contemporary best practices into a pragmatic procedural workflow for redo-TAVR in these settings. This consensus document standardizes key definitions, outlines computed tomography–based strategies for in vivo sizing and risk stratification, and details recommended approaches to predilatation, deployment technique, postdilatation, coronary protection and leaflet modification, or hybrid surgical alternative when needed. A structured troubleshooting guide is provided to support safe, reproducible execution and coronary preservation.

查看原文本刊更多论文

Redo-TAVR （TAV-in-TAV）最佳实践第2部分：高中短和高中高-心脏和瓣膜合作文件。

经导管主动脉瓣置换术（TAVR）导致越来越多的患者需要重新进行TAVR （tavin - tav）来治疗结构性瓣膜恶化。在失效的短框架或高框架经导管瓣膜（“高中短”和“高中高”）内植入高框架自膨胀瓣膜，面临着与锚定、受限扩张、瓣膜对齐以及由此产生的新裙板驱动的冠状动脉阻塞或窦性隔离风险相关的独特挑战。在心脏和瓣膜合作实验室的支持下，一个国际多学科小组审查了实验和临床数据，并将当代最佳实践综合到这些情况下redo-TAVR的实用程序工作流程中。该共识文件标准化了关键定义，概述了基于计算机断层扫描的体内大小和风险分层策略，并详细介绍了扩张前、部署技术、扩张后、冠状动脉保护和小叶修改的推荐方法，或必要时的混合手术选择。提供了结构化的故障排除指南，以支持安全，可重复的执行和冠状动脉保存。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.