In vitro coronary flow after transcatheter aortic valve-in-valve implantation: A comparison of 2 valves

Abstract

In our specific model, in noncalcified as well as calcified conditions, TAVI-ViV is feasible with either SAVB (Trifecta or Perimount Magna Ease) without an increased risk of coronary obstruction. Nevertheless, before clinical application of these results, thorough preoperative assessment, considering the different limitations of this model, is mandatory.

Haemodynamic Issues with Transcatheter Aortic Valve Implantation

“…However, there are also reports that sinus flow alterations as a result of TAVI in aortic roots with low positioned coronary ostia may have a reduction in coronary flow by up to 20% [68]. Coronary ostia have an increased risk of being obstructed when in the vicinity of native leaflets thickened due to calcification, a problem exacerbated by using an oversized TAV relative to the native region [62,71]. The implantation procedure itself can also cause obstruction, whether due to fragmentation of the calcified native leaflet during TAV insertion, high implantation of the TAV, or as a consequence of a balloon expansion method [55].…”

“…Another relevant application of TAVI is their use for the treatment of dysfunctional or underperforming surgical valves [55,66,71], by expanding the device inside a previously implanted bioprosthetic valve, in a valve-in-valve (ViV) configuration.…”

“…However, the increase in stagnation is less severe in the coronary sinuses, as the flow towards the ostia generates some motion in the region [39]. Still, the chance of coronary obstruction is raised after ViV treatment, especially when the original prosthesis had badly calcified leaflets, the ostia are located close to the annulus, the aortic region and STJ have a narrow diameter, and/or the sinuses themselves are particularly narrow [41,68,71,80].…”

Transcatheter aortic valve-in-valve implantation: Go with the flow?

“…They do, however, certainly add another useful piece to the puzzle of leaflet thrombosis that has been reported recently after both transcatheter AVR and surgical AVR with bioprosthetic valves, [6][7][8] a finding that could be even more frequent after ViV procedures and potentially could be counteracted by strict oral anticoagulation. Although this work does not consider other important mechanisms that may impact sinus flow and promote thrombus formation, such as differing designs (internally vs externally mounted BPV), size and calcification degree of the BPV, 9 and finally appropriate sizing and positioning of the valve during ViV implantation, 10 Hatoum and colleagues 5 are to be congratulated for their fundamental work.…”

Transcatheter aortic valve-in-valve insertion: That train has sailed

“…I congratulate Stock and colleagues 1 on their efforts to bring some science to the issue of transcatheter aortic valvein-valve insertion. Members of the multidisciplinary transcatheter heart team will recognize that the technique of transcatheter aortic valve-in-valve insertion did not transition from the benchtop to the operating room, but with the present publication appears to be rightly moving backward from the operating room to the benchtop.…”