Feasibility of Valve in Valve After Transcatheter Aortic Valve Replacement With SAPIEN 3 Valves and Surgical Aortic Valve Replacement - Original Research

Q: What question does the study address about future valve-in-valve procedures?

It evaluates the feasibility of performing future transcatheter aortic valve replacement (TAVR) after prior TAVR or surgical aortic valve replacement (SAVR). Feasibility is assessed using post-treatment computed tomography.

Q: How were patients grouped in the study?

Four groups were analyzed: TAVR with SAPIEN 3 at ≤90% implant depth, TAVR with SAPIEN 3 at >90% implant depth, SAVR, and SAVR with aortic root enlargement (ARE).

Sep 29, 2026

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Feasibility of performing future transcatheter intervention after either transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) is critical for lifelong management of aortic stenosis. A multicenter retrospective study evaluated four patient groups undergoing post-treatment CT, including TAVR with SAPIEN 3 at different implant depths and SAVR, with SAVR plus aortic root enlargement. Results showed the most repeatable initial option and identified challenging anatomies affecting future TAVR.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Article history

Background

Methods

Study design and population

Feasibility criteria and challenging anatomy

Results

Conclusions

Introduction

Methodology

Structural Heart 9 (2025) 100729 Articles and Issues Available at ScienceDirect Structural Heart journal [homepage:](homepage: www.structuralheartjournal.org)[ www.structuralheartjournal.org](homepage: www.structuralheartjournal.org) Original Research Feasibility of Valve in Valve After Transcatheter Aortic Valve Replacement With SAPIEN 3 Valves and Surgical Aortic Valve Replacement Tej Sheth, MDa, *, Warkaa Al-Shamkani, MDa, Ahmed Makhdoum, MDa, Jorge Chavarria Viquez, MDb, Muhammad Suleman, MDa, Alexander Dick, MDc, Janarthanan Sathananthan, MDd, David Wood, MDd, Neil Fam, MDe, Hatim AlRaddadi, MDa, Madhu K. Natarajan, MDa, James L. Velianou, MDa a Division of Cardiology, McMaster University and Hamilton Health Sciences, Hamilton, Canada b Division of Cardiology, Universidad de Costa Rica., San Jose, Costa Rica c University of Ottawa Heart Institute, Ottawa, Canada d Dilawri Cardiovascular Institute and UBC Centre for Cardiovascular Innovation, Vancouver, British Columbia, Canada e Division of Cardiology, St. Michael's Hospital, Toronto, Canada | A R T I C L E I N F O | | A B S T R A C T | | --- | --- | --- | | Article history:
Submitted 23 June 2025
Revised 5 September 2025
Accepted 9 September 2025
Available online 17 September 2025 | | Background: The feasibility of transcatheter intervention after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) is important for the lifetime management of aortic stenosis.
Methods: A multicenter study was conducted of 4 patient groups: (1) TAVR using SAPIEN 3 at ≤90% implant depth,(2) TAVR using SAPIEN 3 at >90% implant depth,(3) SAVR, and (4) SAVR with aortic root enlargement (ARE) who underwent post-treatment computed tomography. Future TAVR was classified as challenging if the simulated neo-skirt was at or above the coronary ostia and <4 mm away from the coronary ostia and/or <2 mm from the sinotubular junction or aortic wall.
Results: A total of 245 patients were evaluated (n = 117 TAVR using SAPIEN 3 at ≤90% implant depth, n = 66 TAVR using SAPIEN 3 at >90% implant depth, n = 31 SAVR, n = 31 SAVR with ARE). The proportion of patients where the simulated neo-skirt was below both coronary arteries was the highest in TAVR with implantation depth ≤90%(47.0%), intermediate in TAVR using SAPIEN 3 at >90% implant depth (22.7%) and SAVR (12.9%), and the lowest in SAVR with ARE (0%),(p < 0.001). Challenging anatomy for future TAVR was identified in 9.8% of TAVR at ≤90% implant depth, 28.8% of TAVR at >90% implant depth, 22.6% of SAVR, and 29.0% of SAVR with ARE (p < 0.001).
Conclusions: Based on post-treatment computed tomography analysis, TAVR with SAPIEN 3 at implant depth ≤90% was the most repeatable initial intervention whereas SAVR with ARE did not improve the feasibility of future TAVR.
ARE, aortic root enlargement; CT, computed tomography; SAVR, surgical aortic valve replacement; SOV, sinus of Valsalva; STJ, sinotubular junction; TAVR, transcatheter aortic valve replacement; VTA, valve to aorta; VTC, valve to coronary. | | Keywords:
Computer tomography
Surgical aortic valve replacement Transcatheter aortic valve replacement
A B B R E V I A T I O N S | | | Introduction In patients undergoing treatment for aortic stenosis, the ability to perform future transcatheter intervention after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) is an important consideration for lifetime management. Feasibility ofTAVR in prior transcatheter or surgical valves is influenced by the height of the neoskirt formed by leaflets of the initial valve and its relationship to the * Address correspondence to: Tej Sheth, MD, McMaster University and Hamilton Health Sciences, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada. E-mail address: [shetht@mcmaster.ca](shetht@mcmaster.ca) (T. Sheth). [https://doi.org/10.1016/j.shj.2025.100729](https://doi.org/10.1016/j.s

FAQs

What question does the study address about future valve-in-valve procedures?

It evaluates the feasibility of performing future transcatheter aortic valve replacement (TAVR) after prior TAVR or surgical aortic valve replacement (SAVR). Feasibility is assessed using post-treatment computed tomography.

How were patients grouped in the study?

Four groups were analyzed: TAVR with SAPIEN 3 at ≤90% implant depth, TAVR with SAPIEN 3 at >90% implant depth, SAVR, and SAVR with aortic root enlargement (ARE).

Which initial intervention was most repeatable for future TAVR, and what was the key limitation?

TAVR with SAPIEN 3 at implant depth ≤90% showed the most repeatable feasibility for future TAVR based on post-treatment CT analysis. In contrast, SAVR with ARE did not improve feasibility for future TAVR.

Sep 29, 2026

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