Key result
Bioprosthetic aortic valve fracture during valve-in-valve TAVI shows promise for improving hemodynamics in smaller valves.
Why the study?
Valve-in-valve transcatheter aortic valve implantation can leave patients with high residual gradients, particularly with smaller surgical bioprostheses, prompting evaluation of the novel concept of fracturing the bioprosthetic valve.
Bioprosthetic valve fracture during valve-in-valve TAVI is a promising novel technique to improve hemodynamic profiles and reduce residual gradients, especially in patients with smaller surgical bioprostheses.
May improve hemodynamics in select valve-in-valve TAVI; hypothesis-generating, requiring prospective trials before practice change.
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.
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O'Donnell et al. (2019) conducted a review in Degenerated bioprosthetic surgical heart valves. Bioprosthetic aortic valve fracture during valve-in-valve transcatheter aortic valve implantation was evaluated. Bioprosthetic aortic valve fracture during valve-in-valve transcatheter aortic valve implantation shows promise for creating a more favorable hemodynamic profile, particularly in smaller valves.
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