Surgical Redo Aortic Valve Replacement: The Emerging Role of Valve-in-Valve TAVR

10.1055/a-2281-1897

We read with great interest the article “Recent Outcomes of Surgical Redo Aortic Valve Replacement” by Kang and colleagues.[1] The authors present important insights into the clinical outcomes of this high-risk population undergoing redo surgical aortic valve replacement (SAVR). The reported data reinforce the significant perioperative risks associated with this complex procedure.

Redo SAVR remains a technically demanding and high-morbidity operation, primarily due to the inherent risks of resternotomy, dense mediastinal adhesions, and challenges in explanting previously implanted valves. These factors often contribute to prolonged operative times, increased blood loss, and a greater incidence of perioperative complications.[2] Furthermore, patient selection often includes older individuals with multiple comorbidities, compounding the inherent surgical risk.

However, while the study provides valuable real-world data, some limitations should be noted. The retrospective design, possible selection bias, and lack of a control group undergoing alternative treatments, such as transcatheter valve-in-valve replacement (ViV-TAVR), limit broader applicability. In recent years, ViV-TAVR has emerged as a promising alternative with encouraging results in selected high-risk patients. The less invasive nature of the procedure and reduced recovery times make it a favorable option in patients with degenerated bioprostheses.[3] [4] [5]

The evolution of transcatheter techniques continues to brighten the future of structural heart interventions. With the progressive refinement in device technology and expanding clinical experience, ViV-TAVR is increasingly shaping a new paradigm in managing failed aortic bioprostheses.

We congratulate the authors for their contribution to the literature and hope that future studies will offer comparative analyses between redo SAVR and ViV-TAVR, helping further inform patient-centered decision-making in this complex clinical context.

Publikationsverlauf

Eingereicht: 25. Juni 2025

Angenommen: 20. September 2025

Artikel online veröffentlicht:
03. Oktober 2025

• References

• 1 Kang Y, Soehartono NA, Choi JW. et al. Recent outcomes of surgical redo aortic valve replacement in prosthetic valve failure. Thorac Cardiovasc Surg 2025; 73 (04) 279-287
• 2 Alghamdi AA, Aqeeli MO, Alshammari FK, Altalhi SM, Bajebair AM, Al-Ebrahim FrcscKE. Cardiac surgery-associated acute kidney injury (CSA-AKI) in adults and pediatrics; prevention is the optimal management. Heart Surg Forum 2022; 25 (04) E504-E509
• 3 Al-Ebrahim KE. Impact of valve in valve aortic valve implantation in valve choice decision making. J Card Surg 2022; 37 (12) 5681
• 4 Raffa H, Al-Ibrahim K, Sorefan AA, Narayanan L. Superimposition of a mechanical valve on an impacted aortic bioprosthesis. Tex Heart Inst J 1991; 18 (03) 199-201
• 5 Al-Ebrahim EK, Madani TA, Al-Ebrahim KE. Future of cardiac surgery, introducing the interventional surgeon. J Card Surg 2022; 37 (01) 88-92