Valve-in-Valve TAVR: State-of-the-Art Review

Edelman, James; Khan, Jaffar; Rogers, Toby; Shults, Christian; Satler, Lowell F.; Ben‐Dor, Itsik; Waksman, Ron; Thourani, Vinod H.

doi:10.1177/1556984519858020

Cited by 45 publications

(43 citation statements)

References 68 publications

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“…Nevertheless, we can learn from the percutaneous treatment of degenerated surgically implanted bioprostheses (TAVI valve-in-valve procedure), already extensively described. The pivotal limiting factor for a second TAVI is the risk of coronary obstruction due to the displacement of the leaflets of the first bioprosthesis: a short and narrow aortic root represents an important risk factor [41]. Interestingly, different device combination could play a role in the success of TAVI in TAVI procedure and, in the future, might influence the choice of the first device to implant [42].…”

Section: Procedural Complicaɵonsmentioning

confidence: 99%

How to deal with low-flow low-gradient aortic stenosis and reduced left ventricle ejection fraction: from literature review to tips for clinical practice

et al. 2021

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Low-flow low-gradient aortic stenosis (LFLG AS) with reduced left ventricle ejection fraction (LVEF) is still a diagnostic and therapeutic challenge. The aim of this paper is to review the latest evidences about the assessment of the valvular disease, usually difficult because of the low-flow status, and the therapeutic options. Special emphasis is given to the available diagnostic tools for the characterization of LFLG AS without functional reserve at stress echocardiography and to the factors that clinicians should evaluate to choose between surgical aortic valve repair, transcatheter aortic valve implantation, or medical therapy.

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Section: Procedural Complicaɵonsmentioning

confidence: 99%

How to deal with low-flow low-gradient aortic stenosis and reduced left ventricle ejection fraction: from literature review to tips for clinical practice

et al. 2021

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“…46 Data for TAVR ViV (TAVR-in-SAVR) procedures are accumulating, and ViV appears to be safer than redo-SAVR in matched registry data; the long-term results are not clear. [47][48][49] The major randomized trials comparing TAVR and SAVR have excluded patients with bicuspid aortic valve disease (BAV). Patients with BAV typically present with aortic valve disease at a younger age and commonly have an associated aortopathy that may benefit from prophylactic replacement.…”

Section: Areas Of Uncertainty and Consensus Discussionmentioning

confidence: 99%

The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies

Thourani¹,

Edelman

Holmes

et al. 2021

Innovations�(Phila)

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Objective There is an increasing amount of evidence supporting use of transcatheter aortic valve replacement (TAVR) for treatment of aortic stenosis in patients at low or intermediate risk for surgical aortic valve replacement (SAVR). TAVR is now approved for use in all patient cohorts. Despite this, there remains debate about the relative efficacy of TAVR compared with SAVR in lower-risk cohorts and various subgroups of patients. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and propensity-matched trials to guide a consensus among expert cardiologists and surgeons. Methods Studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a thorough search of the major databases. Mortality, stroke, and other perioperative outcomes were assessed at 30 days and 1 year. Results Early mortality was lower in TAVR compared to SAVR in RCTs, but not propensity-matched studies in low-risk cohorts (0.66% vs 1.5%; odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20 to 0.98, I2 = 0%). No difference in mortality between TAVR and SAVR was identified in intermediate-risk patients at early or later time points. Incidence of perioperative stroke in 3 low-risk RCTs was significantly lower in TAVR (0.4%) than SAVR (1.4%; OR = 0.33, 95% CI 0.13 to 0.81, I2 = 0%). There was no difference in stroke for intermediate-risk patients between TAVR and SAVR. The expert panel of cardiologists and cardiac surgeons provided recommendations for TAVR and SAVR in various clinical scenarios. Conclusions In RCTs comparing TAVR and SAVR in low-risk patients, early mortality and stroke were lower in TAVR, but did not differ at 1 year. There was no difference in mortality and stroke in intermediate-risk patients. The Multidisciplinary Heart Team must consider individual patient characteristics and preferences when recommending TAVR or SAVR. The decision must consider the long-term management of each patient’s aortic valve disease.

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“… 4 , 11 , 17–24 Risk of coronary flow compromise is highest in the female gender, coronary ostial height below 10 mm, sinus of Valsalva width below 30 mm and with virtual valve-to-coronary distance of less than 4 mm. 13 , 20–25 Lederman et al 13 described five mechanisms of TAVI-induced coronary obstruction ( Table 1 ). BASILICA would apply to cases of initial TAVI, ViV-TAVI, or TAVI-in-TAV, when performing the transcatheter procedure would expose to the risk of coronary flow compromise.…”

Section: Discussionmentioning

confidence: 99%

A case report of open-aorta, direct transcatheter valve-in-valve implantation: an innovative approach to manage the hazard of coronary flow compromise in transcatheter aortic valve re-interventions

Calcaterra

Kaur

Dasari

et al. 2021

European Heart Journal - Case Reports

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Background Coronary flow compromise is a significant risk of transcatheter aortic valve therapy. Warranting preservation of coronary flow is even more challenging with transcatheter aortic valve re-intervention since the implantation of a transcatheter valve within a degenerated bioprosthetic or transcatheter valve increases significantly this hazard. Case summary We present a case of heart failure secondary to transcatheter aortic valve degeneration requiring a transcatheter aortic valve re-intervention. Pre-operative imaging studies demonstrated a high risk for iatrogenic coronary flow impairment. The patient underwent a successful surgical removal of the prosthetic valve leaflets followed by direct transcatheter aortic valve implantation. Conclusion We reviewed the literature on the approach to difficult coronaries in transcatheter aortic valve therapy, and we describe an innovative hybrid approach that may represent a viable alternative in cases where catheter techniques of coronary flow preservation are not applicable.

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Valve-in-Valve TAVR: State-of-the-Art Review

Cited by 45 publications

References 68 publications

How to deal with low-flow low-gradient aortic stenosis and reduced left ventricle ejection fraction: from literature review to tips for clinical practice

How to deal with low-flow low-gradient aortic stenosis and reduced left ventricle ejection fraction: from literature review to tips for clinical practice

The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies

A case report of open-aorta, direct transcatheter valve-in-valve implantation: an innovative approach to manage the hazard of coronary flow compromise in transcatheter aortic valve re-interventions

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