Bioprosthetic Aortic Valve Fracture During Valve-in-valve Transcatheter Aortic Valve Implantation

John Phineas O'Donnell, Cróchán J O'Sullivan, John Phineas O'Donnell, Cróchán J O'Sullivan

Abstract

The limited durability of surgical bioprostheses, combined with an ageing population, has led to an increasing demand for replacing degenerated bioprosthetic surgical heart valves, which is projected to increase. Valve-in-valve transcatheter aortic valve implantation involves implanting a transcatheter heart valve within a degenerated bioprosthetic surgical heart valve. A significant minority of patients, however, are left with a suboptimal haemodynamic result with high residual gradients. This is more common with smaller surgical bioprostheses, and may be associated with a worse prognosis. The novel concept of fracturing the previously implanted bioprosthetic surgical heart valve during valve-in-valve transcatheter aortic valve implantation to create a more favourable haemodynamic profile has shown great promise, particularly in smaller valves. Herein, we describe the benefits, limitations and potential complications of this novel approach.

Keywords: Bioprosthetic aortic valve fracture; transcatheter aortic valve implantation; valve-in-valve.

Conflict of interest statement

Disclosure: CJO has received consultant fees from Edwards Lifesciences. JPO has no conflicts of interest to declare.

Copyright © 2019, Radcliffe Cardiology.

Figures

Figure 1:. Fluoroscopic Images of the Stages…
Figure 1:. Fluoroscopic Images of the Stages of Valve-in-valve Transcatheter Aortic Valve Implantation Followed by Bioprosthetic Valve Fracture
Figure 2:. Images from In Vitro Testing…
Figure 2:. Images from In Vitro Testing Prior to an Early In Vivo Trial
Figure 3:. The Constrained Area of a…
Figure 3:. The Constrained Area of a Self-expanding Transcatheter Heart Valve where the Commissures Attach to the Nitinol Frame

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Source: PubMed

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