A Transcatheter Aortic Valve Implantation also known as TAVI, is designed to last for many years. But like all biological valves, it may gradually wear out over time. When that happens, the question becomes, ‘What next?’
Often, a second minimally invasive procedure known as TAVI-in-TAVI can be performed.
TAVI-in-TAVI is a procedure where a new transcatheter valve is placed inside a previously implanted TAVI valve.
Instead of removing the original valve, the new valve is positioned within it, restoring function and improving blood flow. This approach avoids the need for open-heart surgery in many patients.
Over time, a TAVI valve may undergo Structural Valve Degeneration, which can lead to the following:
When these changes become significant, symptoms such as breathlessness or fatigue may return, indicating the need for further treatment.
Clinical experience and emerging research show that TAVI-in-TAVI is:
However, it is a technically more complex procedure and requires careful planning by an experienced structural heart team.
Placing a second valve inside an existing one is not simply a repeat of the first procedure. It requires careful planning and a detailed understanding of the patient’s anatomy.
Several factors need to be assessed:
Not every patient is an automatic candidate. Suitability depends on the following:
This is why individualised evaluation is essential before deciding the next step.
One of the key considerations when performing the first TAVI is planning for the future.
Experienced centres take into account:
This forward-thinking approach ensures that options like TAVI-in-TAVI remain viable down the line.
TAVI-in-TAVI offers a practical and increasingly reliable solution when a previously implanted valve begins to show signs of failure. Rather than defaulting to repeat open-heart surgery, many patients can now be treated with a second minimally invasive procedure, restoring valve function while reducing recovery time and procedural risk.
What makes this approach particularly valuable is not just the procedure itself but the planning behind it. Careful assessment of valve type, anatomy, and future coronary access plays a crucial role in determining whether TAVI-in-TAVI is feasible and safe. This is why long-term thinking is essential, from the very first valve intervention.
As valve technologies continue to evolve and clinical experience grows, the ability to manage patients over the long term, including the possibility of reintervention, has improved significantly. For patients, this means that treatment is no longer a one-time decision but part of a well-considered, ongoing care pathway.
At Heart Valve Experts, every TAVI procedure is approached with a long-term strategy in mind, ensuring not just immediate success but sustainable outcomes for the future.
Yes, often a failing TAVI valve can be treated with a second procedure called TAVI-in-TAVI, where a new valve is placed inside the existing one without the need for open-heart surgery.
TAVI-in-TAVI is considered a feasible and effective option in selected patients, particularly when performed at experienced centres with careful pre-procedural planning.
Suitability depends on factors such as the type and size of the original valve, coronary anatomy, and overall health. A detailed evaluation by a specialist heart team is required to determine the best approach.
About The Author
With over 15 years of expertise, Dr. Phatarpekar is recognised as a renowned interventional cardiologist in Mumbai, specialising in complex coronary interventions, structural heart procedures, and pioneering work in Transcatheter Aortic Valve Implantation (TAVI).
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