Lifetime Management After TAVR: Durability, Reintervention, and Coronary Access Preservation

The expanding use of transcatheter aortic valve replacement (TAVR) in younger and lower-surgical-risk patients has made lifetime treatment planning a central challenge in structural heart disease. For these patients, the initial procedure must be considered as the first stage of a longer treatment pathway that may include surveillance, redo-TAVR, valve-in-valve intervention, surgical replacement, and further coronary or valve procedures.The central clinical challenge is to preserve future treatment options while achieving a safe and effective initial intervention. This requires careful consideration of prosthesis choice, valve position, commissural alignment, implant depth, coronary anatomy, sinus dimensions, and the potential interaction between the implanted valve and future transcatheter or surgical therapies. Coronary access may become difficult after TAVR, particularly when a future valve-in-valve or redo-TAVR is required. In some anatomies, this can increase the risk of coronary obstruction or prevent reliable coronary re-access, making prevention and mitigation strategies an essential part of lifetime planning.Although mid-term outcomes after TAVR are encouraging, important uncertainties remain regarding long-term durability, the clinical significance and timing of structural valve deterioration (SVD), and the optimal management of failed transcatheter valves. The evidence base for younger patients remains limited, and approaches to surveillance, risk stratification, and the selection of redo-TAVR, valve-in-valve treatment, or surgery continue to evolve. Patient-specific imaging, computational modelling, and procedural planning may help clinicians identify anatomies in which a particular first intervention could compromise future coronary or valve access.This Research Topic will advance clinical and translational understanding of lifetime management after TAVR, with a particular focus on reintervention planning and the preservation of future coronary access. It will bring together evidence on long-term outcomes, surveillance, patient selection, procedural planning, coronary obstruction prevention, and the management of failed transcatheter and surgical bioprostheses. Contributions may address clinical studies, registries, imaging research, computational approaches, procedural techniques, Heart Team decision-making, and translational innovations that support safe sequencing of interventions across a patient’s lifetime.The Research Topic welcomes articles addressing, but not limited to, the following themes:Long-term clinical outcomes and durability of TAVR in younger and lower-surgical-risk patientsSurveillance, imaging, biomarkers, and risk stratification for clinically relevant SVD and bioprosthetic valve failure after TAVRDefinitions, timing, predictors, and management of early, mid-term, and late valve degeneration in clinical practiceClinical outcomes and procedural planning for redo-TAVR and TAV-in-TAV proceduresValve-in-valve treatment for failed surgical bioprostheses when relevant to the TAVR lifetime pathwayCoronary access after TAVR and during subsequent valve interventionsAssessment and prevention of coronary obstruction in native and prosthetic valve anatomiesBASILICA, leaflet modification, chimney stenting, and other coronary obstruction mitigation strategiesProsthesis selection, commissural alignment, implantation depth, and other index-procedure factors affecting future coronary accessCT-based, patient-specific, and computational approaches to lifetime procedural planningHeart Team decision-making between redo-TAVR, transcatheter valve-in-valve treatment, valve explantation, and surgeryManagement of complex or failed transcatheter and surgical bioprostheses within an aortic lifetime treatment strategyOutcomes, complications, and follow-up after coronary or valve reinterventionTechnical, clinical, and health-system strategies for integrating lifetime planning into TAVR programmesThe Topic is intended primarily for clinically oriented research on the aortic TAVR pathway. Topic editors: Molly Szerlip, Michael Young Source: https://www.frontiersin.org/research-topics/86567/lifetime-management-after-tavr-durability-reintervention-and-coronary-access-preservation