Complications of Bioprosthetic Valve Fracture as an Adjunct to Valve-in-Valve TAVR

A bench test study of bioprosthetic valve fracture performed before versus after transcatheter valve-in-valve intervention

“…BVF requires high-pressure balloon inflation with a non-compliant balloon, which might damage THV leaflets leading to both short-and long-term failure. There is a risk of acute leaflet dysfunction leading to aortic insufficiency and haemodynamic compromise 19 . Crimping of THVs has been shown to cause damage to the surface layers of leaflets 20 .…”

Is timing everything? Bioprosthetic valve fracture in valve‐in‐valve TAVR

“…2,4 While best practices for V-in-V TAVR have been outlined previously, these recommendations are largely based on case series and long term durability has not yet been established. 5 A small animal study did not show evidence of early valve deterioration after highpressure balloon inflation, though this study only evaluated effects in only balloon expandable TAV. 6 Understandably, there are concerns regarding procedural success, post-TAVR valve hemodynamics, thromboembolus, safety, and possible hemodynamic instability following BFV before TAV implantation.…”

“…While BVF is an accepted strategy to optimize valvular hemodynamics when pursuing V‐in‐V TAVR and some data suggest BVF following TAV implantation results in improved hemodynamic profiles, the impact of high‐pressure balloon inflation on bioprosthetic leaflet integrity remains unknown 2,4 . While best practices for V‐in‐V TAVR have been outlined previously, these recommendations are largely based on case series and long term durability has not yet been established 5 . A small animal study did not show evidence of early valve deterioration after high‐pressure balloon inflation, though this study only evaluated effects in only balloon expandable TAV 6 .…”

Will valve-in-valve transcatheter aortic valve replacement shift the treatment paradigm for young adults with aortic valve disease?

“…Similarly, in the CoreValve valve-in-valve registry, preexisting severe PPM was not associated with three-year mortality but was associated with significantly less improvement in quality-oflife at mid-term follow-up (9). Although bioprosthetic valve fracture has been used as an adjunct to valve-in-valve TAVR to improve postprocedural hemodynamics and eliminate PPM, life-threatening complications, such as annular rupture, coronary obstruction, and iatrogenic ventricular septal defect, and limited experience may preclude its routine adoption (10).…”