Surgical vs TranscatheterFriday, July 24, 2026

The Role of Preprocedural CT in Redo Transcatheter Aortic Valve Replacement: A Radiologist's Perspective.

1 min read·By E. Nolan Beckett, MD·Source: Radiology. Cardiothoracic imaging

From The Valve Wire

This radiology-perspective review outlines what preprocedural CT must accomplish before redo TAVR (TAV-in-TAV): identify the mechanism of index THV failure (structural vs nonstructural), assess index valve type and geometry, evaluate commissural and coronary alignment achieved at the original procedure, and quantify the risks of coronary obstruction, impeded future coronary access, and the potential need for leaflet modification.

The assessment overlaps with valve-in-SAV planning but has distinct considerations rooted in the index THV design.

This is a technique-focused review rather than an outcomes study, but it addresses one of the most consequential blind spots in contemporary structural heart practice.

As TAVR expands into younger patients under both ACC/AHA 2020 and, more aggressively, ESC 2025 (which now recommends TAVI at age ≥70 with suitable tricuspid anatomy), the redo-TAVR question moves from theoretical to inevitable.

Source Abstract

As transcatheter aortic valve replacement (TAVR) has become a viable option across all surgical risk levels, younger patients are anticipated to outlive the durability of their index transcatheter heart valve (THV). When a THV fails, cardiac CT is an important tool to assess the mechanism of THV failure and aids in the differentiation between structural and nonstructural THV dysfunction mechanisms. After the identification of the index THV dysfunction mechanism, CT guides the sizing and selection of the new THV type. While the principles of preprocedural redo TAVR (often called TAV-in-TAV) CT assessment overlap with those for patients undergoing TAVR of surgical bioprosthetic valves, the assessment is different in several ways. These differences are primarily related to the need to evaluate the characteristics of the index THV and the degree of commissural and coronary alignment achieved during the index TAVR procedure, which affect the selection of the type and size of the new THV and determine the risks of coronary obstruction and impeded future coronary access, as well as the potential for leaflet modification. Keywords: Applications-CT, CT Angiography, Transcatheter Aortic Valve Implantation/Replacement, TAVI/TAVR Supplemental material is available for this article. ©RSNA, 2026.

Authors: Jukema RA, Levene E, Khoo JK, Bugis R, Haugan D et al.

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