Transcatheter Valve-in-Valve and Valve-in-Ring for Treating Aortic and Mitral Surgical Prosthetic Dysfunction

Abstract

Bioprosthetic valve use has increased significantly. Considering their limited durability, there will remain an ongoing clinical need for repairing or replacing these prostheses in the future. The current standard of care for treating bioprosthetic valve degeneration involves redo open-heart surgery. However, repeat cardiac surgery may be associated with significant morbidity and mortality. With the rapid evolution of transcatheter heart valve therapies, the feasibility and safety of implanting a transcatheter heart valve within a failed tissue valve has been established. We review the historical perspective of transcatheter valve-in-valve therapy, as well as the main procedural challenges and clinical outcomes associated with this new less invasive treatment option.

Transcatheter aortic valve implantation in patients with small aortic annuli using a 20 mm balloon-expanding valve

“…The Society of Thoracic Surgeons (STS) score (http://riskcalc.sts.org/de.aspx) and/or the Logistic EuroSCORE (http://www.euroscore.org/calcold.html) were used to predict operative mortality in the event of conventional SAVR for each patient undergoing TAVI or V-in-V. Internal diameters of previously implanted surgical valves were provided by each site and were derived from their respective labels and manufacturing charts 11. Aortic annular measurements were obtained from 3D CT exams and valve sizing was based on manufacturer recommendations and the Valve in Valve app (for V-in-V procedures).…”

Transcatheter aortic valve implantation. Expert Consensus of the Association of Cardiovascular Interventions of the Polish Cardiac Society and the Polish Society of Cardio-Thoracic Surgeons, approved by the Board of the Polish Cardiac Society…

“…The mean mortality rate at one year was 15.1%. Factors associated with increased mortality were smaller surgical valves, stenotic dysfunction and transapical approach [42].…”

Transcatheter Mitral Valve Replacement

“…This phenomenon has not been limited to the use of surgical prostheses, and it has also been described following transcatheter mitral procedures with nondedicated devices. The reported rate of acute LVOT obstruction with transcatheter mitral valve-in-ring procedures is 8.2% (14), and it increases up to 9.3% following TMVR in the presence of severe mitral annular calcification (13). Multiple factors should be evaluated when determining the risk of LVOT obstruction after TMVR (22,23): the aortomitralannular angle, which is the angle between the annular planes of these 2 valves (if the angle is obtuse, there may be a higher risk of obstruction, as the struts of the prosthesis will encroach on the LVOT); degree of septal hypertrophy; left ventricle size; and device protrusion and flaring into the LVOT.…”