Catheter balloon valvuloplasty of stenotic porcine bioprosthetic valves: Part II: Mechanisms, complications, and recommendations for clinical use

Abstract

Summary:During the last several years dilating balloons have been applied in the treatment of stenotic cardiac valves. This interest has been extended to stenotic porcine bioprosthetic valves. Part I of this review discusses the pathologic changes producing stenotic porcine prosthetic valves. Part I1 of this review describes an in vitro study of porcine prosthetic valve valvuloplasty defining the mechanisms, complications, and clinical applications. Results of this study indicate a limited and cautious role in balloon dilation of stenotic bioprosthetic valves.

The effect of balloon valvuloplasty for bioprosthetic valve stenosis at pulmonary positions

“…The mechanisms of bioprosthetic valve failure are attributed to several processes, including intrinsic calcification, cuspal tearing, perforation and cuspal thrombosis . Commissural fusion and a rigid stent frame may be favorable factors for balloon valvuloplasty, whereas cuspal calcification and tearing may be undesirable factors . Nevertheless, balloon valvuloplasty of bioprosthetic valves at pulmonary positions has rarely been performed.…”

“…Balloon valvuloplasty is a highly effective and safe method for treating acute and chronic congenital pulmonary valvular stenosis . However, bioprosthetic valve failure has a very different nature from congenital valve stenosis . A few reports have explored balloon dilatation to treat bioprosthetic valve failure, mainly at aortic positions .…”

Management of Congenital Aortic Stenosis by Catheter Techniques

“…Balloon aortic valvuloplasty has been attempted in stenosed surgical bioprostheses with mixed results in literature. Majority admit it has limited application with great caution in some instances and disappointment in others (Kirwan et al, 2004;Waller et al, 1991). The reason is that the bioprosthetic valve leaflets are at relatively high risk of tearing resulting in dehiscence, regurgitation or embolism.…”

Prosthetic mitral valvuloplasty

“…Most of the criticism results from in vitro studies using explanted mitral bioprostheses. These studies suggest that the increased MVA attained from balloon valvuloplasty results from balloon-induced leaflet tearing, calcium fractures, and cusp perforation [12][13][14]. In a study performed intraoperatively prior to planned repeat valve replacement, there was direct visualization of ballooninduced bioprosthetic valvular damage, with each case complicated by severe mitral regurgitation [14].…”

“…The percutaneous approach may delay or avoid the hazards of repeat mitral valve surgery [11], but should be restricted to highly selected patients who have no evidence of thrombosis, regurgitation, or subvalvular fibrous tissue ingrowth [12]. Even with these exclusions, there may still be a subpopulation of patients in which the potential palliative benefits of valvuloplasty outweigh the risk of repeat thoracotomy.…”