Computed tomography (CT) planning for Redo-transcatheter aortic valve implantation (TAVI): a step-by-step approach and structured reporting.
The expansion of transcatheter aortic valve implantation (TAVI) indications to younger and lower-risk patients has led to an increasing incidence of late transcatheter valve failure. In this setting, redo-TAVI (TAV-in-TAV) has emerged as a less invasive alternative to surgical valve explantation, albeit with specific anatomical and technical challenges, particularly related to the risk of coronary obstruction. Computed tomography (CT) plays a pivotal role in preprocedural planning by enabling detailed characterisation of the index valve, identification of the failure mechanism, assessment of commissural and coronary alignment, accurate internal valve measurements, and definition of the neoskirt plane. This pictorial essay presents a step-by-step CT-based approach to redo-TAVI planning, illustrating the main implantation strategies and their relationship with the coronary risk plane. In addition, a structured reporting template is proposed to standardise CT interpretation and support multidisciplinary Heart Team decision-making.
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