Transcatheter Valve-in-Valve Therapies: Patient Selection, Prosthesis Assessment and Selection, Results, and Future Directions

Abstract

The development of transcatheter valve implantations (TAVI) has induced profound changes in the treatment of valvular heart disease over the past decade. At the same time, due to excellent clinical results, bioprostheses continuously outperformed mechanical prostheses. The increasing number of elderly patients has led to numerous patients presenting with deteriorated bioprostheses needing reoperation. In selected high-risk patients or patients with unreasonable surgical risk, valve-in-valve TAVI has advanced to a viable alternative to conventional redo surgery. High procedural success, good hemodynamics and acceptable clinical results were reported up until now. Valve-in-valve TAVI seems to be safe and effective in treatment of deteriorated valve prostheses in high-risk patients. The valve-in-valve concept presents the next step toward an individual treatment strategy for patients at prohibitive risk for conventional surgery. Present studies were reviewed with special concern to patient selection, prosthesis assessment, device selection, clinical outcome and technical challenging aspects as well.

Transcatheter Aortic Valve Replacement for Bioprosthetic Aortic Valve Failure

“…7,[20][21][22] A Canadian registry (n=24) was soon followed by an Italian registry (n=25), 2 German registries (n=20, n=47), and numerous other small case series and isolated case reports documenting favorable outcomes. 7,8,[23][24][25][26][27][28][29][30][31] The Global Valve-in-Valve Registry, an industry-independent collaboration, was introduced in 2010 to collate this increasing but widely distributed experience.…”

Transapical Mitral Valve-in-Valve Implantation Using an Edwards SAPIEN 3 Prosthesis

“…Proper valve sizing remains a challenge in VIV cases because native prostheses may have smaller diameters than expected because of calcification or pannus formation. 9 Choosing adequate valve sizes is essential for good hemodynamic function as underexpanded valves have the tendency to have higher transvalvular gradients and in some cases intravalvular regurgitation. Thorough preoperative imaging remains crucial to properly handle this challenge.…”

Transcatheter Aortic Valve Implantation Under Direct Visualization in Homograft Valve Endocarditis

“…Nevertheless, technical difficulties such as prior cardiac surgical procedures with dense adhesions, porcelain aorta, and high Society of Thoracic Surgeons risk score may eventually preclude or substantially increase the risk of SVR. Whereas transcatheter valve-in-valve (TViV) is contraindicated in patients with PVE, it may constitute an important resource in selected, prohibitive surgical risk scenarios [3,4]. We describe the implantation of a selfexpandable transcatheter heart valve under direct visualization in a patient with homograft aortic valve endocarditis.…”