Implantation Depth in Small Valve-in-Valve TAVR

Shinichi Shirai; Masaomi Hayashi; Kenichi Ishizu

doi:10.1016/j.jacasi.2026.08.022

October 1, 2026JACC AsiaOpen Access

Implantation Depth in Small Valve-in-Valve TAVR

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Graphical abstract published by JACC Asia — Graphical abstract · Published by JACC Asia · CC BY-NC-ND 4.0

Why the study?

Does varying transcatheter heart valve implantation depth improve hemodynamics and leaflet mechanics in 21-mm surgical bioprostheses during valve-in-valve TAVR?

Structured PICO

Does varying transcatheter heart valve implantation depth improve hemodynamics and leaflet mechanics in 21-mm surgical bioprostheses during valve-in-valve TAVR?

P

Population

In vitro bench model of 5 different 21-mm surgical bioprostheses (Hancock II, Mosaic, Perimount, Magna Ease, and Epic)

I

Intervention

Valve-in-valve transcatheter aortic valve replacement (TAVR) using a 21-mm VitaFlow transcatheter heart valve (THV) implanted across multiple implantation depths

C

Comparator

Varying implantation depths within each specific surgical bioprosthesis architecture

O

Outcome

Hemodynamics (transvalvular pressure gradients and effective orifice area), leaflet deformation, pinwheeling, and accelerated wear (up to 200 million cycles)surrogate

Limitations

Evaluated only one THV platform (21-mm VitaFlow) and nominally 21-mm surgical bioprostheses under controlled in vitro conditions
Accelerated wear testing cannot reproduce the complex biological environment of a degenerated surgical valve (e.g., calcification, leaflet tears, pannus, eccentric degeneration, thrombotic tendency)
Pulse duplicator lacks patient anatomical constraints such as coronary height, sinus dimensions, sinotubular junction anatomy, aortic angulation, and coronary obstruction risk
Implantation depth measured on the bench may not map directly onto clinical fluoroscopic or computed tomographic measurements

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Implication

This editorial highlights that optimal implantation depth in small valve-in-valve TAVR is not a single universal target, but depends on the specific interaction between transcatheter and surgical valve architectures to balance immediate hemodynamics with long-term leaflet mechanics.

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Cite This Study

Shirai et al. (2026) studied this question.

synapsesocial.com/papers/6ac6e50382aa59ee98b3ff24 https://doi.org/10.1016/j.jacasi.2026.08.022

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Implantation Depth in Small Valve-in-Valve TAVR

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Implantation Depth in Small Valve-in-Valve TAVR

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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