Transcatheter Valve Implantation in Failed Surgically Inserted Bioprosthesis

Abstract

An increased use of bioprosthetic heart valves has stimulated an interest in possible transcatheter options for bioprosthetic valve failure given the high operative risk. The encouraging results of transcatheter aortic valve implantation in high-risk surgical candidates with native disease have led to the development of the transcatheter valve-in-valve (VIV) procedures for failed bioprostheses. VIV procedures are unique in many ways, and there is an increased need for multimodality imaging in a team-based approach. The echocardiographic approach to VIV procedures has not previously been described. In this review, we summarize key echocardiographic requirements for optimal patient selection, procedural guidance, and immediate post-procedural assessment for VIV procedures.

Transcathether Valve Replacement and Valve Repair

“…74,75 Echocardiographic imaging can be an adjunctive imaging modality and has been well described in a recent review. 76 Although mitral prostheses fail more commonly than aortic, most studies in the literature have reported on the aortic VIV procedure. In the Valve-in-Valve International Data Registry with data from 55 participating sites, multivariable determinants of 1-year mortality were as follows: surgical valve ≤21 mm, stenosis as the mode of failure, transapical access, and Society of Thoracic Surgeons score.…”

Entrapped Stent Delivery Catheter Shaft After High Risk TAVI: Retrieval & Lessons Learned

“…Transcather aortic valve replacement for a deteriorating surgical valve in the aortic position is an approved therapy for both the self-expanding Medtronic and the balloon expandable EDWARDS valves. Coronary occlusion is a recognized complication of the TAVR procedure with a slightly higher incidence in the VIV procedures (as cited in Hamid et al, 2015). One of the protective strategies in high coronary occlusion risk TAVR is to place a coronary an undeployed stent in the coronary artery.…”