Transcatheter Aortic Valve-in-Valve Implantation for Patients With Degenerative Surgical Bioprosthetic Valves

Valve in valve implantation of the CoreValve Evolut R in degenerated surgical aortic valves

“…The combination of a small surgical valve and the necessity of two transfemoral valves probably resulted in an unchanged gradient over the aortic valve. This result is comparable with the literature for the previous generation of self-expanding valve-invalve procedures with a rate which required a second valve of 7.5% [8].…”

“…Nevertheless, ViV implantations in patients with suspected prosthesis-patient mismatch should be reserved for patients with very high operative risk. The rate of insufficient reduction of the transaortic gradient was 19% and therefore comparable with the rate for postprocedural elevated gradients in small valves of 23.4% for a previous generation of self-expanding valves [8].…”

“…The third pacemaker was implanted due to ,most likely preexisting, sick sinus syndrome. This rate is comparable to the rate of permanent pacemaker implantation after valve-in-valve procedure with previous generations of self-expanding valves [8].…”

“…While clearly limited by the low number of patients included, the present data suggests that the new CoreValve Evolut R is suited for successful interventional treatment of degenerated surgical prosthetic valves. This is an improvement over data for the older generation of self-expanding valves with a rate for at least moderate regurgitation of 8.9% [8].…”

Optimising the Haemodynamics of Aortic Valve-in-valve Procedures

“…In addition, underexpansion results in a higher gradient after VIV procedure (average mean gradient of 15.8 ±8.9 mmHg reported in the VIVID Registry) as compared to regular transcatheter valve implants in native aortic valves (5-10 mmHg), therefore creating unique challenges and considerations for the VIV procedure. 6,13 These haemodynamic considerations are critical because studies have shown that elevated post-procedural mean gradient is associated with worse clinical outcomes. 14 In addition, an elevated post-procedural mean gradient is inherently present with prosthesis-patient mismatch (PPM), defined as having too small of an effective orifice area in relation to the patient's body size.…”