Key result
Bioprosthetic valve fracture facilitates ViV-TAVR by optimizing THV expansion and reducing patient-prosthesis mismatch risk.
Why the study?
VIV TAVR often results in suboptimal THV expansion and patient-prosthesis mismatch in failed surgical tissue valves, which may be overcome by BVF and BVR.
Bioprosthetic valve fracture and remodeling can facilitate valve-in-valve TAVR by optimally expanding the transcatheter heart valve and reducing residual transvalvular gradients.
BVF/BVR may lower gradients after small-valve VIV TAVR; leaves open durability, optimal timing, and safety in larger cohorts.
Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) is currently indicated for the treatment of failed surgical tissue valves in patients determined to be at high surgical risk for re-operative surgical valve replacement. VIV TAVR, however, often results in suboptimal expansion of the transcatheter heart valve (THV) and can result in patient-prosthesis mismatch (PPM), particularly in small surgical valves. Bioprosthetic valve fracture (BVF) and bioprosthetic valve remodeling (BVR) can facilitate VIV TAVR by optimally expanding the THV and reducing the residual transvalvular gradient by utilizing a high-pressure inflation with a non-compliant balloon to either fracture or stretch the surgical valve ring, respectively. This article, along with the supplemental video, will provide patient selection, procedural planning and technical insights for performing BVF and BVR.
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Allen et al. (2021) conducted a review in Failed bioprosthetic surgical valves requiring valve-in-valve TAVR. Bioprosthetic valve fracture (BVF) and remodeling (BVR) was evaluated. Bioprosthetic valve fracture facilitates valve-in-valve transcatheter aortic valve replacement by optimally expanding the transcatheter heart valve and reducing the risk of patient-prosthesis mismatch.
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