Computer‐assisted valve in valve in a deteriorated Mosaic valve using a library of bioprostheses

Abstract

Valve‐in‐valve (ViV) procedures have emerged from an off‐label procedure to a safe and efficient alternative to redo aortic valve replacement in the treatment of symptomatic structural valve deterioration (SVD). During ViV procedures, optimal placement of the transcatheter heart valve (THV) inside the degenerated bioprosthesis is of paramount importance regarding complications such as device embolization, coronary obstruction, periprosthetic regurgitation, residual gradients, and mitral valve injury, but also for the attainment of optimal hemodynamics. In the case of the Mosaic (Medtronic, Minneapolis, MN) valve, the limited radiopaque landmarks represent a challenge to a reproducible, optimal implantation. Such implantation may require multiple contrast injections and transesophageal echocardiogram (TEE) guidance. We herein describe a computer‐assisted ViV procedure inside a deteriorated Mosaic valve, achieving reproducible optimal placement using a preacquired library of bioprostheses 3D models. Our approach suggests an evolving paradigm in ViV procedures, from safe and efficient toward optimal therapy for symptomatic SVD.

Computer-Assisted Transcatheter Mitral Valve Implantation for Valve-in-Valve Procedures

“…The 3D/2D fusion of CT-scan derived images onto fluoroscopic images have been used in the context of TAVI-ViV [ 5 ] . Superimposing a representation of the LVOT during the procedure on live fluoroscopy images (augmented imaging) might help visualizing its relationship with the balloon-expandable THV and guide valve deployment.…”

“…Second, we match the degenerate BVS-mesh and its correspondent undeteriorated BVS-mesh from our library of bioprosthesis [ 5 ] ( Figure 1A ). We applied an iterative closest point algorithm to align the two BVS-meshes.…”

Transcatheter Mitral Valve-in-Valve Implantations Using Inverted J-Valve

“…Usage of inverted TAVR prosthesis in TMVIV has been widely reported ( 11 , 12 ). Mid-term reports from multiple cohorts have shown acceptable results using SAPIEN 3 [(Edwards Lifesciences), Melody (Medtronic, Minneapolis, MN), Lotus (Boston Scientific, Natick, MA, USA) and Direct Flow (Direct Flow Medical Inc., Santa Rosa, CA, USA)] ( 13 – 17 ).…”