Why the study?
Bioprosthetic heart valve deterioration frequently necessitates reintervention, and expanding TAVR indications to younger patients raise concerns regarding long-term durability and potential valve failure.
This review provides an overview of valve-in-valve TAVR for failed bioprosthetic valves, emphasizing pre-procedural planning, techniques, and complication management.
Offers practical guidance on valve-in-valve TAVR; leaves open need for prospective trials to validate techniques.
Over the last decades, bioprosthetic heart valves (BHV) have been increasingly implanted instead of mechanical valves in patients undergoing surgical aortic valve replacement (SAVR). Structural valve deterioration (SVD) is a common issue at follow-up and can justify the need for a reintervention. In the evolving landscape of interventional cardiology, valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has emerged as a remarkable innovation to address the complex challenges of patients previously treated with SAVR and has rapidly gained prominence as a feasible technique especially in patients at high surgical risk. On the other hand, the expanding indications for TAVR in progressively younger patients with severe aortic stenosis pose the crucial question on the long-term durability of transcatheter heart valves (THVs), as patients might outlive the bioprosthetic valve. In this review, we provide an overview on the role of ViV TAVR for failed surgical and transcatheter BHVs, with a specific focus on current clinical evidence, pre-procedural planning, procedural techniques, and possible complications. The combination of integrated Heart Team discussion with interventional growth curve makes it possible to achieve best ViV TAVR results and avoid complications or put oneself ahead of time from them.
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Muro et al. (2024) studied this question.
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