Transcatether Aortic Valve Implantation to Treat Degenerated Surgical Bioprosthesis: Focus on the Specific Procedural Challenges

Figures

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  Figure 1. The key points of a VIV procedure to optimize outcomes and minimize the risk of operative complications.

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  Figure 2. True internal diameter (ID) of stented and stentless surgical aortic valves. In stented valves with porcine leaflets sutured inside (Epic) true ID is at least 2 mm < the stent ID. In stented valves with pericardial leaflets sutured inside (Perimount) true ID is at least 1 mm < the stent ID. In pericardial valves with leaflets sutured outside (Mitroflow) true ID is the same as the stent ID. In the stentless valves (Toronto), which do not possess a rigid stent frame, the true ID is always smaller than the labeled size, which corresponds to the root diameter.

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  Figure 3. Incidence of coronary obstruction. The incidence of coronary obstruction is four folders greater in TAVI for degenerative bioprosthetic valves compared to TAVI for native aortic valves. The risk of coronary obstruction is also correlated to the type of SHV. Indeed it is highest during VIV TAVI procedures for surgical bioprothesis designs intended to maximize effective aortic orifice area (such as “stented” bioprostheses that have externally mounted leaflets, and “stentless” surgical bioprostheses).