Transcatheter Aortic Valve Replacement for Degenerative Bioprosthetic Surgical Valves

Abstract

Background-Transcatheter aortic valve-in-valve implantation is an emerging therapeutic alternative for patients with a failed surgical bioprosthesis and may obviate the need for reoperation. We evaluated the clinical results of this technique using a large, worldwide registry. Key Words: bioprosthesis Ⅲ transcatheter aortic valve implantation Ⅲ valve-in-valve M ore than 200 000 surgical aortic valve replacements (SAVR) are performed annually worldwide, with a substantial shift toward the use of bioprostheses rather than mechanical valves. 1 Bioprostheses have limited durability, and most are expected to degenerate and eventually fail within 10 to 20 years. 2-4 As a result, it is estimated that in the subsequent few years, many patients will suffer from failed surgical bioprosthetic valves. Reoperation, the standard of care for these patients, is occasionally a high-risk procedure that carries significant mortality and morbidity risks, especially because many of these patients are elderly and have numerous comorbidities. [5][6][7] Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz. Methods and Results-The

Transcatheter Aortic and Mitral Valve‐in‐Valve Implantation Using the Edwards Sapien 3 Heart Valve

“…Registry and in vitro data suggest that supra‐annular THVs are associated with lower gradients after aortic VIV procedures; however, technical factors, such as future access to the coronary vessels, concerns about THV recoil associated with self‐expanding devices, or use of deliberate bioprosthetic ring fracture, may prompt selection of a balloon‐expandable intra‐annular THV 11, 16, 29, 30, 31, 32. While randomized comparisons of the transvalvular gradient after S3 versus supra‐annular THV implantation in surgical bioprostheses have not been performed, accurate sizing, positioning, and deployment of the S3 is clearly essential in order to achieve a good functional outcome with low transvalvular gradients.…”

“…In this regard, MDCT enables accurate assessment of the height of the coronary ostia in relation to the surgical bioprosthesis and the width of the aortic sinus. Low coronary height (<12 mm) and/or small sinus of Valsalva diameter (<30 mm) will increase the risk for coronary artery obstruction during native valve TAVR,33 and aortic VIV procedures are associated with a higher risk 29. Unfavorable anatomy identified on MDCT may prompt avoidance of a VIV procedure altogether; it may also direct the implanter to use balloon sizing, or use a risk‐minimization strategy, such as less aggressive valve oversizing and deeper valve implantation, to avoid coronary artery occlusion.…”

Who is the next for aortic valve implantation? Present and future indications

“…According to these findings, transcatheter aortic VIV implantation has emerged as a viable and less-invasive technique to be used in this setting and to obviate the need for reoperation. Despite being a technique still in progress, performed especially in specialized centers, a worldwide register is now available (Global Valve-in-Valve Registry) [51] , aiming to evaluate the effectiveness and clinical results of this technique in a wide cohort of patients. Before the creation of this register, previous studies investigating the VIV technique included only a small number of cases and were therefore limited in providing conclusive results.…”

Transcatheter Aortic Valve Replacement for Failed Surgical Bioprostheses: Insights from the PARTNER II Valve-in-Valve Registry on Utilizing Baseline Computed-Tomographic Assessment

“…6,7 Preliminary data from the Valve-in-Valve International Data (VIVID) Registry revealed that although procedural success is achieved in the majority of patients, the procedure includes several safety and efficacy concerns, including elevated post procedural gradients and coronary obstruction. 8 Over the last decade multidetector computed tomography (MDCT) has asserted itself as an important tool for the assessment of patients prior to TAVR and has been shown to help improve clinical outcomes. 9,10,11 Pre-procedural screening with 3-dimensional MDCT has resulted in a reduction in paravalvular regurgitation and also a more comprehensive evaluation of coronary obstruction risk.…”