Key result
Transcatheter valve-in-valve procedures are less invasive than re-do open heart surgery for degenerated bioprostheses, with generally lower morbidity and mortality risks in registries.
Why the study?
Does transcatheter valve-in-valve implantation improve outcomes compared to re-do open heart surgery in patients with degenerated surgical bioprostheses?
Does transcatheter valve-in-valve implantation improve outcomes compared to re-do open heart surgery in patients with degenerated surgical bioprostheses?
Transcatheter valve-in-valve procedures offer a less invasive, safe, and effective alternative to re-do surgery for degenerated bioprostheses, though specific procedural and durability concerns remain.
May support valve-in-valve in high-risk patients; leaves open durability and need for randomized trials.
Transcatheter valve-in-valve (VIV) procedures are less invasive than re-do open heart surgery, and have proven relatively safe and effective. In large multicentre registries morbidity and mortality risks are generally lower than with surgery, and improvement in quality of life can be profound. Outcomes continue to improve with advances in transcatheter heart valve (THV) technology, techniques, and expertise. However specific concerns remain; including residual stenosis, coronary obstruction, left ventricular outflow tract obstruction, and thrombosis. The unknown durability is a concern in patients with the potential for longevity. Transcatheter VIV procedures will likely increasingly be favoured over reoperation when bioprosthetic heart valves fail, particularly when surgical risks are high.
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Murdoch et al. (2018) conducted a review in Degenerated surgical bioprostheses. Transcatheter valve-in-valve (VIV) implantation vs. Re-do open heart surgery was evaluated. Transcatheter valve-in-valve procedures are less invasive than re-do open heart surgery for degenerated bioprostheses, with generally lower morbidity and mortality risks in registries.
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