TAVI-in-TAVI — Is this the future?

Jędrzejczyk, Szymon; Ścisło, Piotr; Grodecki, Kajetan; Rymuza, Bartosz; Kochman, Janusz; Huczek, Zenon

doi:10.5603/cj.2019.0104

Cited by 2 publications

(2 citation statements)

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“…Considering the rapid increase in the number of TAVI procedures, the need for subsequent reinterventions is expected to rise dramatically. In this setting, coronary artery access and coronary obstruction prevention become extremely relevant [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Taking into account the increasing number of low-risk patients undergoing TAVI and their long-life expectancy, one can assume that patients could outlive the bioprostheses’ expected durability. Consequently, the number of repeated transcatheter interventions following the first TAVI, the so-called TAVI-in-TAVI procedure, is also expected to increase [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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The Use of BASILICA Technique to Prevent Coronary Obstruction in a TAVI-TAVI Procedure

Tagliari

Saadi

Medronha

et al. 2021

JCM

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Transcatheter aortic valve implantation (TAVI) to manage structural bioprosthetic valve deterioration has been successful in mitigating the risk of a redo cardiac surgery. However, TAVI-in-TAVI is a complex intervention, potentially associated with feared complications such as coronary artery obstruction. Coronary obstruction risk is especially high when the previously implanted prosthesis had supra-annular leaflets and/or the distance between the prosthesis and the coronary ostia is short. The BASILICA technique (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) was developed to prevent coronary obstruction during native or valve-in-valve interventions but has now also been considered for TAVI-in-TAVI interventions. Despite its utility, the technique requires a not so widely available toolbox. Herein, we discuss the TAVI-in-TAVI BASILICA technique and how to perform it using more widely available tools, which could spread its use.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Use of BASILICA Technique to Prevent Coronary Obstruction in a TAVI-TAVI Procedure

Tagliari

Saadi

Medronha

et al. 2021

JCM

View full text Add to dashboard Cite

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Transcatheter aortic valve replacement for structural degeneration of previously implanted transcatheter valves (TAVR-in-TAVR): a systematic review

Gallo

Fovino

Blitzer

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Transcatheter aortic valve replacement (TAVR) represents a valid treatment for patients with aortic valve stenosis and high or intermediate surgical risk. However, biological transcatheter valves can also experience a structural degeneration after years, and a redo-TAVR procedure (TAVR-in-TAVR) can be a valid option. We revised the current available literature for indications, procedural and technical details and outcome on TAVR-in-TAVR procedures for degenerated TAVR valves. METHODS A systematic search was conducted in the public medical database for scientific articles on TAVR-in-TAVR procedures for degenerated transcatheter valves. Data on demographics, indications, first and second transcatheter valve type and size, mortality, complications and follow-up were extracted and analysed. RESULTS A total of 13 studies (1 multicentre, 3 case series, 9 case reports) were included in this review, with a total amount of 160 patients treated with TAVR-in-TAVR procedures for transcatheter valve failure. The mean age was 74.8 ± 7.8 with 84 males (52.8%). The mean elapsed time from the first TAVR procedure was 58.1 ± 23.4 months. Main indication for TAVR-in-TAVR was pure stenosis (38.4%, with mean gradient of 44.5 ± 18.5 mmHg), regurgitation (31.4%), mixed stenosis and regurgitation (29.5%) and leaflet thrombosis (8.8%). Procedural success rate was 86.8%, with second TAVR valve malposition occurred in 4 cases (2.5%). The hospital mortality rate was 1.25% (2/160). Post-procedural echocardiographic control showed moderate regurgitation in 5.6% of patients (9/160) and residual transvalvular mean gradient ≥20 mmHg in 5% of cases. Postoperative complications included major vascular complications (8.7%), new pacemaker implantation (8.7%), acute kidney failure (3.7%), stroke (0.6%) and coronary obstruction (0.6%). The mean follow-up time was 6 ± 5.6 months with 1 non-cardiovascular death reported. CONCLUSIONS TAVR-in-TAVR represents a valid alternative to standard surgery for the treatment of degenerated transcatheter valves in high-risk patients. Despite these promising results, further studies are required to assess durability and haemodynamic performances of the second TAVR valve.

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TAVI-in-TAVI — Is this the future?

Cited by 2 publications

References 0 publications

The Use of BASILICA Technique to Prevent Coronary Obstruction in a TAVI-TAVI Procedure

The Use of BASILICA Technique to Prevent Coronary Obstruction in a TAVI-TAVI Procedure

Transcatheter aortic valve replacement for structural degeneration of previously implanted transcatheter valves (TAVR-in-TAVR): a systematic review

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