Valve-in-valve transcatheter aortic valve replacement: the challenge of the next future

Gianmarco Annibali,Innocenzo Scrocca,Giuseppe Musumeci

doi:10.20517/2574-1225.2021.101

Abstract

In recent years, an increasing number of bioprostheses have been implanted, and in the near future more and more patients will be candidates for reoperation due to structural deterioration of the valve. Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become a safe and effective alternative to surgery and is currently approved for higher-risk, inoperable patients. From the most recent studies, early mortality has decreased and improvements in symptoms and quality of life of treated patients have been documented. ViV TAVR is a complex procedure that can present many pitfalls and therefore must be performed in high volume centers and with experienced staff because the risk of peri- and post-procedural complications is much higher than TAVR on native valve. In this review, we analyze the main procedural issues reported in the literature during ViV TAVR procedures: elevated postprocedural gradients, coronary obstruction and thrombosis of the leaflets of the bioprosthesis. Because of the opening of TAVR to younger and younger patients, thus with a longer life expectancy than the durability of the bioprosthesis, the next challenge will be the management of the lifetime strategy of patients with aortic stenosis, as the first type of intervention will influence all future therapeutic choices of our patient.

Highlights

IntroductionTranscatheter aortic valve replacement (TAVR) has dramatically changed the www.misjournal.net
Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement (SAVR) in patients at high operative risk, accounting for approximately 5% of all TAVR procedures performed in the United States[1]
ViV TAVR is a safe, effective and well-established procedure supported by increasingly convincing data

Summary

Introduction

Transcatheter aortic valve replacement (TAVR) has dramatically changed the www.misjournal.net. To identify a dysfunctional valve, in 2017, a consensus document from the European Society of Interventional Cardiology (EAPCI), the European Society of Cardio-Thoracic Surgery, and the European Society of Cardiology defined structural valve deterioration as: (1) mean gradient ≥ 40 mmHg and/or ≥ 20 mmHg change from baseline (before discharge or within 30 days of valve implantation); and/or (2) severe new or worsening intra-prosthetic aortic regurgitation[5]. In the Valve Academic Research Consortium (VARC)-3, four main categories of aortic bioprosthetic dysfunctions have been defined, based on the main etiopathogenetic mechanisms: structural valve deterioration (SVD), non-structural valve deterioration (NSVD) (e.g., paravalvular regurgitation and prosthesis-patient mismatch), thrombosis and endocarditis[6]

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Conclusion