Key result
Bioprosthetic valve fracture in ViV TAVR allows larger valves to reduce gradients and PPM risk.
Why the study?
Increasing bioprosthetic valve use has led to more aortic valve reinterventions, but ViV TAVR carries risks of higher gradients and patient prosthesis mismatch.
Bioprosthetic valve fracture during valve-in-valve TAVR allows for placement of a larger transcatheter valve, decreasing postoperative gradients and the risk of patient prosthesis mismatch.
The use of bioprosthetic prostheses during surgical aortic valve replacements has increased dramatically over the last two decades, accounting for over 85% of surgical implantations. Given limited long-term durability, there has been an increase in aortic valve reoperations and reinterventions. With the advent of new technologies, multiple treatment strategies are available to treat bioprosthetic valve failure, including valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR). However, ViV TAVR has an increased risk of higher gradients and patient prosthesis mismatch (PPM) secondary to placing the new valve within the rigid frame of the prior valve, especially in patients with a small surgical bioprosthesis in situ. Bioprosthetic valve fracture allows for placement of a larger transcatheter valve, as well as a fully expanded transcatheter valve, decreasing postoperative gradients and the risk of PPM.
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Norton et al. (2022) conducted a review in Failed bioprosthetic aortic valves. Valve-in-valve transcatheter aortic valve replacement (TAVR) and bioprosthetic valve fracture was evaluated. Bioprosthetic valve fracture during valve-in-valve TAVR allows for placement of a larger transcatheter valve, decreasing postoperative gradients and the risk of patient prosthesis mismatch.
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