Failed bioprosthetic valve approaches: Transcatheter aortic valve replacement approach

Abstract

Bioprosthetic valves will fail, given enough time. All prosthetic valves, whether mechanical or biological, are beset with nonstructural valve deterioration due to such causes as infective endocarditis and pannus formation, but bioprosthetic valves are uniquely prone to structural valve deterioration (SVD) caused by calcification or wear, leading to either stenosis or regurgitation (Figure 1, A and B). 1 The combination of SVD and non-SVD constitutes what is now termed bioprosthetic valve failure (BVF). 2 A transcatheter approach to SVD using the valve-in-valve (VIV) procedure is now well accepted for the treatment of SVD. But should aortic VIV be the preferred procedure for most patients?

Transcatheter Aortic Valve Implantation for Bioprosthetic Valve Failure: Placement of Aortic Transcatheter Valves 3 Aortic Valve-in-Valve Study

“…Screen failures are an impediment of valve choice today but may be mitigated by procedures such as BASILICA. 16,17 Valve thrombosis event rates were higher than those reported in previous low-risk TAVI trials. 18,19 The 1-year outcomes of the PARTNER 3 main trial 18 detailed 5 cases (1.0%) of valve thrombosis in the TAVI cohort, none of which were associated with clinical sequelae.…”

“…Screen failures are an impediment of valve choice today but may be mitigated by procedures such as BASILICA. 16 , 17 …”

Commentary: Management of bioprosthetic valve failure—strategic planning for the future

“…We read with great interest the invited expert opinion by Clark and colleagues. 1 Treatment of bioprosthetic structural valve deterioration is an increasingly challenging clinical entity, and the authors are to be congratulated for their concise yet extensive overview. We agree with the authors' appraisal of existing literature in that the valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) approach to structural valve deterioration appears to be associated with favorable outcomes over reoperative surgical aortic valve replacement (re-SAVR), at least in the short term.…”

Commentary: When you wish upon a valve…

“…In this issue of the Journal, the 2 sides of the redo SAVR versus TAVR ViV argument are presented. Clark and Malaisrie 1 argue that TAVR ViV provides the safest approach to the patient with a failed tissue valve, whereas Greason 2 argues that redo SAVR fixes the problem.…”