# Lifetime Management of Transcatheter Aortic Valve Replacement: A Guide to Decision-Making and Future Reinterventions

## TL;DR

This paper provides a guide for managing TAVR over a patient's lifetime, focusing on decision-making and future interventions.

## Contribution

The paper introduces a comprehensive framework for optimizing TAVR planning and future reinterventions using CT and multidisciplinary collaboration.

## Key findings

- CT planning is critical for optimizing initial TAVR and predicting future reintervention feasibility.
- Strategies to minimize complications like patient-prosthesis mismatch and paravalvular regurgitation improve outcomes.
- TAVR-in-TAVR procedures require careful assessment of risk planes and coronary access preservation.

## Abstract

Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis, evolving from a therapy reserved for inoperable patients to a first-line option across all surgical risk categories. As TAVR expands to younger patients with longer life expectancies, lifetime management strategies become paramount. This comprehensive review examines the important role of computed tomography (CT) planning in optimizing initial valve selection and predicting future reintervention feasibility. We discuss the decision framework between TAVR and surgical aortic valve replacement (SAVR) as initial therapy, strategies to optimize the index TAVR procedure, including minimizing patient-prosthesis mismatch, reducing paravalvular regurgitation, preventing conduction abnormalities and coronary obstruction, and facilitating future reinterventions. For patients requiring redo procedures, we analyse TAVR-in-TAVR considerations, including risk plane assessment, coronary access preservation, and leaflet modification techniques. Future directions include advances in valve design, artificial intelligence integration in procedural planning, and development of personalized risk assessment tools. Successful lifetime management requires multidisciplinary collaboration and individualized treatment planning to optimize outcomes throughout a patient’s lifetime journey with aortic valve disease.