Timing of bioprosthetic valve fracture in transcatheter valve-in-valve intervention: impact on valve durability and leaflet integrity

Meier, David; Payne, Geoffrey W.; Mostaço-Guidolin, Leila B.; Bouchareb, Rihab; Rich, Courtney; Lai, Althea; Chatfield, Andrew G.; Akodad, Mariama; Salcudean, Hannah; Lutter, Georg; Puehler, Thomas; Allen, Keith B.; Chhatriwalla, Adnan K.; Søndergaard, Lars; Wood, David; Webb, John G.; Leipsic, Jonathon; Sathananthan, Janarthanan; Sellers, Stephanie

doi:10.4244/eij-d-22-00644

Cited by 8 publications

(4 citation statements)

References 22 publications

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“…Although the herein investigated patient collective is small, postoperative hemodynamics are exceptionally favorable for ViV procedures using an intra-annular THV, even though it has to be emphasized that the herein documented hemodynamic results may be prone to bias since in two patients BVF was performed prior to THV implantation and hemodynamic performance of the utilized THV was determined after BVF. Furthermore, recent data suggest a beneficial impact of BVF after THV implantation with superior long-term effective orifice area ( 7 ), while still a patient-specific approach regarding utilization of BVF should be made for every patient to balance the anticipated hemodynamic result against the risk of coronary occlusion. However, these results suggest that not only valve position is crucial for postinterventional hemodynamics in ViV procedures but also the stent design itself.…”

Section: Discussionmentioning

confidence: 99%

“…However, certain drawbacks of this procedure were especially described concerning suboptimal hemodynamic results in patients with small bioprostheses or risk of coronary occlusion in patients with low coronary ostia take-off ( 5 , 6 ). In the past, several procedural steps were introduced to overcome these possible complications including bioprosthetic valve fracture (BVF) to optimize hemodynamic results and intentional leaflet laceration to mitigate the risk of coronary occlusion ( 7 , 8 ). In terms of postinterventional hemodynamic results, traditionally self-expanding (SE) supra-annular THV are considered to present superior hemodynamics compared with balloon-expandable (BE) intra-annular THV ( 9 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

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Valve-in-valve procedures for degenerated surgical and transcatheter aortic valve bioprostheses using a latest-generation self-expanding intra-annular transcatheter heart valve

Schaefer,

Demal,

Bhadra

et al. 2023

Front. Cardiovasc. Med.

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BackgroundValve-in-valve (ViV) transfemoral transcatheter aortic valve implantation (TAVI) for failing aortic surgical bioprostheses or transcatheter heart valves (THV) has demonstrated a reasonable clinical and hemodynamic efficacy. Traditionally, self-expanding (SE) supra-annular THV are considered to result in superior hemodynamics compared with balloon-expandable intra-annular THV after ViV. However, so far no data are found on latest-generation intra-annular SE THV for aortic ViV procedures which might be superior with regard to coronary access or subsequent valve reintervention.AimWe herein aim to evaluate a latest-generation SE intra-annular THV for aortic ViV procedures.Materials and methodsBetween May 2022 and November 2022, five consecutive patients (4/5 female with mean age of 76.2 years and mean Society of Thoracic Surgeons predicted risk of mortality score of 2.9%) received ViV TAVI using the Navitor system (Abbott, Chicago, IL, USA) for treatment of failing surgical bioprostheses or THV. Data were retrospectively analyzed according to updated Valve Academic Research Consortium 3 (VARC-3) definitions.ResultsAt 30 days, absence of mortality and VARC-3 adjudicated clinical endpoints were documented. Echocardiography at 30 days revealed complete absence of paravalvular leakage and single-digit mean transvalvular gradients (mean of 6.0 mmHg) in all patients.ConclusionThe investigated intra-annular SE THV results in excellent 30-day outcomes for aortic ViV procedures for failing surgical bioprostheses or THV. Despite the intra-annular design, hemodynamic results were excellent, even in small bioprostheses. Ease of use of this valve platform is reflected by only two cycles of resheathing in five ViV procedures with hemodynamic stability during all steps of valve deployment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Valve-in-valve procedures for degenerated surgical and transcatheter aortic valve bioprostheses using a latest-generation self-expanding intra-annular transcatheter heart valve

Schaefer,

Demal,

Bhadra

et al. 2023

Front. Cardiovasc. Med.

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“…BVF before TAVI may ease implantation of SEV, while it may cause significant acute aortic regurgitation and post-dilatation might still be needed. BVF after TAVI may further improve expansion of the transcatheter prosthesis, while it can, on the other hand, risk migration of the TAVI device and potential harm to its leaflets [25,26]. It should be noted that not all SAVs can be fractured, and this should be checked beforehand.…”

Section: Procedural Considerationsmentioning

confidence: 99%

Transcatheter Aortic Valve Implantation to Treat Degenerated Aortic, Mitral and Tricuspid Bioprosthesis

Khokhar,

Curio,

Sticchi

et al. 2024

JCM

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Transcatheter aortic valve implantation (TAVI) is now well established as the treatment of choice for patients with native aortic valve stenosis who are high or intermediate risk for surgical aortic valve replacement. Recent data has also supported the use of TAVI in patients at low surgical risk and also in anatomical subsets that were previously felt to be contra-indicated including bicuspid aortic valves and aortic regurgitation. With advancements and refinements in procedural techniques, the application of this technology has now been further expanded to include the management of degenerated bioprosthesis. After the demonstration of feasibility and safety in the management of degenerated aortic bioprosthetic valves, mitral and tricuspid bioprosthetic valve treatment is now also well-established and provides an attractive alternative to performing redo surgery. In this review, we appraise the latest clinical evidence and highlight procedural considerations when utilising TAVI technology in the management of degenerated aortic, mitral or tricuspid prosthesis.

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“…Fracturing the old prosthesis with balloon expansion in order to maximise the effective orifice area can improve haemodynamic results. Post-TAVI fracture may result in less leaflet damage and be safer than pre-TAVI fracture 12. TAVI-in-TAVI has already been performed both as for an acute complication related to the first TAVI and due to long-term valve dysfunction.…”

Section: Expanding Indications For Tavimentioning

confidence: 99%

Future of transcatheter aortic valve implantation: where do we go from here?

Patel

Baumbach

2023

Heart

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Timing of bioprosthetic valve fracture in transcatheter valve-in-valve intervention: impact on valve durability and leaflet integrity

Cited by 8 publications

References 22 publications

Valve-in-valve procedures for degenerated surgical and transcatheter aortic valve bioprostheses using a latest-generation self-expanding intra-annular transcatheter heart valve

Valve-in-valve procedures for degenerated surgical and transcatheter aortic valve bioprostheses using a latest-generation self-expanding intra-annular transcatheter heart valve

Transcatheter Aortic Valve Implantation to Treat Degenerated Aortic, Mitral and Tricuspid Bioprosthesis

Future of transcatheter aortic valve implantation: where do we go from here?

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