Surgical Bioprostheses Research Articles

Aortic Valve Replacement Using a Perceval Sutureless Aortic Bioprosthesis

Surgical aortic valve replacement (AVR) has undergone many changes in the last decade, with the most significant factor for change being the success of transcatheter AVR therapy. Surgical changes include minimally invasive surgical techniques that have been developed, which contribute to an easier recovery and less morbidity. Also these smaller incisions are more acceptable to the patient population than standard median sternotomy. Surgical aortic bioprostheses have provided durable, safe, and proven outcomes for many years for surgical AVR. Innovation of these bioprostheses has produced a new type of valve that allows rapid deployment, thus shortening the operative time for implantation. In addition, these bioprostheses simplify a minimally invasive approach. The Perceval surgical valve is a rapid-deployment valve that is sutureless, with leaflets of bovine pericardium housed in a nitinol frame. The expanding nitinol frame allows for secure placement in the debrided aortic annulus, and implantation is streamlined with the help of guiding sutures that can be removed once the valve is seated. Implantation is achieved without the need for permanent suture placement, saving significant cross-clamp time. The incidence of aortic insufficiency is similar to the low rate achieved with standard surgical AVR, supporting good surgical outcomes. The Perceval valve is a major factor that can contribute to a more efficient and less invasive surgical approach to AVR that promotes better outcomes as well as an easier recovery to surgical patients undergoing AVR.

Expanding Indications of Transcatheter Heart Valve Interventions.

Transcatheter aortic valve replacement (TAVR) has been established as a less invasive alternative to open-heart surgery in inoperable or high-risk patients presenting with symptomatic severe aortic valve stenosis. The feasibility and efficacy of valve-in-valve implantation in degenerated surgical aortic bioprostheses have also been described and can currently be considered a valuable treatment option in patients deemed unsuitable for repeat cardiac surgery. However, the clinical use of TAVR devices is not limited to the treatment of the tricuspid stenotic aortic valve. Several additional indications including treatment of the bicuspid stenotic aortic valve, aortic regurgitation, and valve-in-valve or valve-in-ring implantation in the mitral or tricuspid position as well as treatment of pure mitral, tricuspid, or pulmonary regurgitation have been described. The purpose of the present review is to summarize the available evidence concerning the emerging off-label use of TAVR devices in current clinical practice. Case examples have been selected to highlight the main procedural steps of each particular intervention.

How Can We Help a Patient With a Small Failing Bioprosthesis?: An In Vitro Case Study.

The aim of this study was to investigate the hemodynamic performance of a transcatheter heart valve (THV) deployed at different valve-in-valve positions in an in vitro model using a small surgical bioprosthesis. Patients at high surgical risk with failing 19-mm surgical aortic bioprostheses are not candidates for valve-in-valve transcatheter aortic valve replacement, because of risk for high transvalvular pressure gradients (TVPGs) and patient-prosthesis mismatch. A 19-mm stented aortic bioprosthesis was mounted into the aortic chamber of a pulse duplicator, and a 23-mm low-profile balloon-expandable THV was deployed (valve-in-valve) in 4 positions: normal (bottom of the THV stent aligned with the bottom of the surgical bioprosthesis sewing ring) and 3, 6, and 8 mm above the normal position. Under controlled hemodynamic status, the effect of these THV positions on valve performance (mean TVPG, geometric orifice area, and effective orifice area), thrombotic potential (sinus shear stress), and migration risk (pullout force and embolization flow rate) were assessed. Compared with normal implantation, a progressive reduction of mean TVPG was observed with each supra-annular THV position (normal: 33.10 mm Hg; 3 mm: 24.69 mm Hg; 6 mm: 19.16 mm Hg; and 8 mm: 12.98 mm Hg; p < 0.001). Simultaneously, we observed increases in geometric orifice area (normal: 0.83 cm(2); 8 mm: 1.60 cm(2); p < 0.001) and effective orifice area (normal: 0.80 cm(2); 8 mm: 1.28 cm(2); p < 0.001) and reductions in sinus shear stresses (normal: 153 dyne/cm(2); 8 mm: 40 dyne/cm(2); p < 0.001), pullout forces (normal: 1.55 N; 8 mm: 0.68 N; p < 0.05), and embolization flow rates (normal: 32.91 l/min; 8 mm: 26.06 l/min; p < 0.01). Supra-annular implantation of a THV in a small surgical bioprosthesis reduces mean TVPG but may increase the risk for leaflet thrombosis and valve migration. A 3- to 6-mm supra-annular deployment could be an optimal position in these cases.

Mitral valve-in-valve hemodynamic performance: An in vitro study

ObjectivesThe valve-in-valve (VinV) procedure may be used in high-risk patients with failed mitral surgical bioprostheses. The objective of this in vitro study was to assess the hemodynamic function of different VinV configurations. MethodsA double activation duplicator was used to test 11 valve configurations (surgical bioprostheses alone) and 15 VinV configurations (Sapien [Edwards Lifesciences, Irvine, Calif] implanted within the surgical bioprosthesis) under 8 different hemodynamic conditions. The internal orifice diameter (IOD) of the surgical bioprosthesis was measured with a Smartscope (OGP Multi Sensor Measuring Instruments, Singapore). ResultsThe VinV procedure was associated with significant deterioration in antegrade hemodynamic parameters compared with valve configuration (effective orifice area, 1.51 ± 0.21 cm2 vs 1.65 ± 0.37 cm2; P < .001 and regurgitant fraction, 11.5% ± 7.2% vs 4.8% ± 3.8%; P < .001). Among the 120 tested experimental VinV situations, moderate or greater mitral stenosis occurred in 52 situations and mild or greater regurgitation occurred in 28 situations. The IOD of the surgical bioprosthesis was the main independent determinant of effective orifice area and regurgitant fraction. An IOD < 22 mm was associated with higher risk of significant mitral stenosis, particularly when the oversizing was >20%, and IOD > 23 mm was associated with higher risk of paravalvular regurgitation when oversizing was <8%. ConclusionsThis in vitro study shows that VinV within mitral surgical bioprostheses provides satisfactory hemodynamic results in the majority of patients. However, significant mitral stenosis is more likely to occur when the IOD of the surgical bioprosthesis is <22 mm, and particularly when the percentage of oversizing is >20%. Significant paravalvular regurgitation is rare and occurs with larger IODs and lower percentage of oversizing (8%).

Possible Subclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves

BackgroundA finding of reduced aortic-valve leaflet motion was noted on computed tomography (CT) in a patient who had a stroke after transcatheter aortic-valve replacement (TAVR) during an ongoing clinical trial. This finding raised a concern about possible subclinical leaflet thrombosis and prompted further investigation.MethodsWe analyzed data obtained from 55 patients in a clinical trial of TAVR and from two single-center registries that included 132 patients who were undergoing either TAVR or surgical aortic-valve bioprosthesis implantation. We obtained four-dimensional, volume-rendered CT scans along with data on anticoagulation and clinical outcomes (including strokes and transient ischemic attacks [TIAs]).ResultsReduced leaflet motion was noted on CT in 22 of 55 patients (40%) in the clinical trial and in 17 of 132 patients (13%) in the two registries. Reduced leaflet motion was detected among patients with multiple bioprosthesis types, including transcatheter and surgical bioprostheses. Therapeutic anticoagulation with warfarin, as compared with dual antiplatelet therapy, was associated with a decreased incidence of reduced leaflet motion (0% and 55%, respectively, P=0.01 in the clinical trial; and 0% and 29%, respectively, P=0.04 in the pooled registries). In patients who were reevaluated with follow-up CT, restoration of leaflet motion was noted in all 11 patients who were receiving anticoagulation and in 1 of 10 patients who were not receiving anticoagulation (P<0.001). There was no significant difference in the incidence of stroke or TIA between patients with reduced leaflet motion and those with normal leaflet motion in the clinical trial (2 of 22 patients and 0 of 33 patients, respectively; P=0.16), although in the pooled registries, a significant difference was detected (3 of 17 patients and 1 of 115 patients, respectively; P=0.007).ConclusionsReduced aortic-valve leaflet motion was shown in patients with bioprosthetic aortic valves. The condition resolved with therapeutic anticoagulation. The effect of this finding on clinical outcomes including stroke needs further investigation. (Funded by St. Jude Medical and Cedars–Sinai Heart Institute; Portico-IDE ClinicalTrials.gov number, NCT02000115; SAVORY registry, NCT02426307; and RESOLVE registry, NCT02318342.)

Abstract 19473: Safety and Efficacy of Second Generation Self Expanding Portico® Valve System for the Treatment of Failed Aortic Bioprosthesis: Results From an International Multicenter Valve-in-Valve Registry

Background: Portico valve is a second-generation self-expanding repositionable system with a nitinol stent frame and bovine pericardial leaflets, which is increasingly utilized for transcatheter aortic valve replacement (TAVR) . In this report, we describe the procedural and early clinical results from an international multicenter registry of Portico implantation in patients with degenerated aortic bioprosthesis (Portico ViV). Methodology: Baseline data and outcomes were collected on standard case report forms and by the Valve-in-Valve International Data network from 14 centers across three continents. Procedural endpoints included implantation success and coronary obstruction. Clinical endpoints included death, myocardial infarction (MI), stroke, major bleeding at 30 days as defined by Valve Academic Research consortium II (VARCII). Result: 45 patients undergoing Portico ViV were included in analysis. The mean age was 79± 7 years with STS (mortality) score of 7±4. These procedures had mainly utilized peripheral arterial access (93%), with transesophageal echocardiogram guidance (60%) for treatment of surgical valve label size ≤21, &gt;21-&lt;25, and ≥25mm in 36, 38 and 27% respectively. Four (9%) of the failed surgical bioprostheses were stentless. Successful implantation was achieved in 44 (98%) cases with no malposition events or clinically-evident coronary obstruction. Post implantation valve area was 1.3 ±0.4 cm2, mean gradient of 17.1 ± 7.7 mmHg and ≥ moderate aortic insufficiency was observed in 3 (7%). One death (2%) related to ischemic stroke occurred within 30 days. Major bleeding and vascular complication in 5 (11%) and 1 (2%) respectively. One patient required permanent pacemaker implantation (2%). Conclusion: Results from this international multicenter registry show that Portico offers a safe and effective treatment of failed surgical bioprosthesis with an added advantage of device retrievability, resulting in low incidence of malpositioning and coronary obstruction. Additional studies and comparison with other transcatheter devices should further determine the hemodynamic and clinical performance of this device for selection of optimal treatment of high risk patients with failed surgical bioprostheses

Transcatheter Aortic and MitralValve-in-Valve Implantation for FailedSurgical Bioprosthetic Valves: An 8-Year Single-Center Experience.

We report our 8-year experience in transcatheter aortic and mitral valve-in-valve (VinV) implantation. Feasibility and good early outcomes associated with transcatheter aortic and mitral VinV implantation into failed surgical bioprostheses have been confirmed, but the mid-term and long-term outcomes of transcatheter aortic and mitral VinV is unknown. A total of 73 patients with aortic (n= 42) and mitral (n= 31) bioprosthetic valve dysfunction underwent transcatheter VinV implantation between April 2007 and December 2013. Edwards balloon-expandable transcatheter valves (Edwards Lifesciences Inc., Irvine, California) were used. Median follow-up was 2.52 years with a maximum of 8 years. Seventy-two patients (mean age 79.7 ± 9.4 years, 32 women) underwent successful VinV implantation (success rate 98.6%). At 30 days, all-cause mortality was 1.4%, disabling stroke 1.4%, life-threatening bleeding 4.1%, acute kidney injury requiring hemodialysis 2.7%, and coronary artery obstruction requiring intervention 1.4%. No patient had greater than mild paravalvular leak. Estimated survival rates were 88.9%, 79.5%, 69.8%, 61.9%, and 40.5% at 1, 2, 3, 4, and 5 years, respectively. The small surgical valve size (19 and 21 mm) was an independent risk factor for reduced survival in aortic VinV patients. At 2-year follow-up, 82.8% of aortic and 100% of mitral VinV patients were in New York Heart Association functional class I or II. Transcatheter VinV for failed surgical bioprostheses can be performed safely with a high success rate and minimal early mortality and morbidity. Transcatheter VinV provides encouraging mid-term clinical outcomes in this high-risk elderly cohort of patients. Transcatheter VinV is an acceptable alternative therapy for failed aortic or mitral bioprostheses in selected high-risk patients.

TCT-102 SAPIEN 3 implantation in failed surgical aortic bioprostheses: Matched comparison and Insights from the Valve-in-Valve International Data (VIVID) Registry

TCT-102 SAPIEN 3 implantation in failed surgical aortic bioprostheses: Matched comparison and Insights from the Valve-in-Valve International Data (VIVID) Registry

TCT-622 Is there a therapeutic limit to sequential aortic valve-in-valve? Hydrodynamic analysis of sequential valve-in-valve using the novel Inovare prosthesis in surgical aortic bioprosthesis

The sequential implantation of a transcatheter heart valve (THV) within a similar device, also known as valve-in-valve-in-valve, will be an important concept in the future, considering patients with elevated surgical risk and failed THVs within surgical aortic valves (SAV). However, this procedure

TCT-91 Comparison of Portico® and CoreValveTM Self-expanding Transcatheter Heart Valves for the Treatment of Failed Surgical Aortic Bioprosthesis: Insights from the Valve in Valve International Data (VIVID) Registry

Portico® (St. Jude Medical) and CoreValve™ (Medtronic) are both nitinol based self-expanding transcatheter heart valves with unique features enabling device retrievability for Portico and supra annular valve position for CoreValve systems. In this study, we sought to investigate the effect of the

TCT-96 Self-Expanding TAVR in Patients with Failed Surgical Bioprosthesis: Results from the CoreValve US Expanded Use Study

TCT-96 Self-Expanding TAVR in Patients with Failed Surgical Bioprosthesis: Results from the CoreValve US Expanded Use Study

First in human implantation of the mechanical expanding Lotus® valve in degenerated surgical valves in mitral position.

Implantation of transcatheter heart valves (THV) into degenerated surgical valves is an emerging therapy for selected high-risk patients. Although, CE mark of most THV is limited for native aortic valvular stenosis, transcatheter valve implantation into degenerated bioprostheses, even in mitral position is very intriguing. After placement of a cerebral protection device (Claret Sentinel®), three consecutive patients (age, 79.0 ± 6.1; log EuroSCORE I: 33.3 ± 9.2%) with a degenerated mitral bioprosthesis were treated by transapical implantation of the Lotus® valve (Boston Scientific Inc.). In addition, a SwanGanz catheter was introduced in the pulmonary artery for hemodynamic assessments all patients. Procedural success was 100%. Valve implantation was performed without rapid ventricular pacing. Resheating was performed in two patients due to suboptimal initial positioning. Invasive online hemodynamics revealed stable blood pressure in all patients. After Lotus® valve implantation, valvular mitral regurgitation was completely eliminated in all patients. One patient had a mild paravalvular leak of the surgical bioprosthesis, which was present before implantation. Invasive right and left heart hemodynamics showed an immediate improvement after Lotus® valve implantation. Mean mitral surface area (2.1 ± 0.2 cm(2) ) and mean gradient (3.7 ± 2.1 mm Hg) demonstrated satisfactory results. All patients were immediately extubated and discharged from the hospital without any adverse event. This study demonstrates for the first time the feasibility of transapical Lotus® Valve implantation in degenerated mitral bioprostheses. The controlled mechanical Lotus® valve expansion with remarkably stable hemodynamics throughout the procedure offers a new and valuable treatment option.

Durability of devices: long-term results and clinical outcomes.

Over the last decade, transcatheter aortic valve implantation (TAVI) has emerged to become the treatment of choice for inoperable patients and the preferred alternative for high-risk patients with severe, symptomatic aortic stenosis (AS). Questions about the long-term durability of TAVI valves were raised early in the history of the procedure. Although there has not yet been a significant signal of early structural valve deterioration (SVD), these concerns remain important today, especially if TAVI is to be considered for use in lower-risk and younger patients with longer life expectancy. Durability expectations for TAVI to some degree parallel those of surgical bioprostheses, but the different tissue, mounting design and crimping of TAVI devices might adversely influence long-term results. The experience with surgical bioprostheses has shown that deterioration of these valves is a slow and gradual process. Thus, despite promising midterm results of many surgical bioprostheses at five to seven years, design faults with higher failure rates have become manifest eight to 10 years after implantation. Similarly, although the initial five-year outcomes of TAVI are promising, these results cannot yet be extrapolated to predict long-term durability with any firm degree of assuredness, especially in younger patient populations. Thus, a high degree of caution is necessary when considering TAVI in intermediate-risk and younger patients until more evidence of durability equivalent to that of surgical bioprostheses is forthcoming.

Patient and procedure selection for the prevention of prosthesis-patient mismatch following aortic valve replacement.

Prosthesis-patient mismatch (PPM) is frequent following surgical aortic valve replacement (SAVR) and is associated with an increased risk of morbidity and mortality. Preventive strategies to avoid or minimise PPM should be implemented in patients who are at high risk (i.e., patients with a small aortic annulus or those undergoing a valve-in-valve procedure within a small surgical bioprosthesis) and/or vulnerable to PPM (i.e., depressed left ventricular [LV] systolic function, severe LV hypertrophy, concomitant mitral regurgitation, and paradoxical low-flow, low-gradient aortic stenosis). Recent studies suggest that transcatheter aortic valve replacement (TAVR) may be superior to SAVR for the prevention of PPM and associated adverse cardiac events, particularly in the subset of patients with a small (<21 mm) aortic annulus. However, further randomised studies are needed to confirm the potential superiority of TAVR for this purpose.

Transcatheter valve-in-valve therapy using 6 different devices in 4 anatomic positions: Clinical outcomes and technical considerations

ObjectivesTranscatheter valve-in-valve implantation (ViV) is emerging as a novel treatment option for patients with deteriorated bioprostheses. We report our cumulative experience using 6 types of transcatheter heart valves (THVs) in all anatomic positions. MethodsSeventy-five consecutive patients (74.1 ± 12.9 years, 50.7% male (38/75), logEuroSCORE I 26.2% ± 17.8%, STS-PROM 8.8% ± 7.4%) receiving ViV procedures from 2008 to 2014 were included for analysis. Data were prospectively gathered and retrospectively analyzed. ResultsViV was performed in aortic (72.0%, 54/75), mitral (22.7%, 17/75), tricuspid (2.7%, 2/75), and pulmonary (2.7%, 2/75) positions. THVs used were Edwards SAPIEN (XT)/SAPIEN3 (52.0%, 39/75), Medtronic Core Valve/Core Valve Evolut(R) (34.7%, 26/75), St Jude Portico (4.0%, 3/75), Boston Scientific Lotus (4.0%, 3/75), Jena Valve (2.7%, 2/75), and Medtronic Engager (2.7%, 2/75). Interval from index procedure to ViV was 9.3 ± 4.9 years. Access was transapical in 53.3% (40/75), transfemoral (transarterial or transvenous) in 42.7% (32/75), transaortic in 2.7% (2/75), and transjugular in 1.3% (1/75). ViV was successful in 97.3% (73/75) with 2 patients requiring sequential THV implantation for initial malpositioning. Overall immediate procedural (≤72 hours) and all-cause 30-day mortality were 2.7% (2/75) and 8.0% (6/75). Corresponding values after aortic ViV were 1.9% (1/54) and 5.6% (3/54). No periprocedural strokes or cases of coronary obstruction occurred. Paravalvular leakage was less than or equal to mild in all cases. After aortic ViV, gradients were max/mean 34.1 ± 14.2/20.1 ± 7.1 mm Hg and effective orifice area (EOA) was 1.5 ± 1.4 cm2. Corresponding values after mitral ViV were gradients max/mean 14.2 ± 8.2/4.7 ± 3.1 mm Hg and EOA 2.4 ± 0.9 cm2. ConclusionsViV can be performed in all anatomic positions with acceptable hemodynamic and clinical outcome in high-risk patients. Increasing importance of ViV can be anticipated considering growing use of surgical bioprostheses.

Transcatheter valve-in-valve implantation for surgical aortic bioprosthesis dysfunction

ABSTRACT Background Recent studies have demonstrated the efficacy of the transcatheter valve-in-valve implantation for the treatment of bioprosthesis dysfunction in high-risk surgical patients. This study presents the initial experience with valve-in-valve implantation. Methods Clinical, echocardiographic, and procedural profiles were characterized, and the mid-term results of patients with surgical bioprosthesis dysfunction submitted to valve-in-valve implantation in the aortic position were reported. Results Seven male patients were included, aged 72.6 ± 10.0 years. The STS score was 9,6 ± 10,5%, and the logistic EuroSCORE was 22.7 ± 14.7%. Three patients had combined aortic bioprosthesis failure; two had isolated regurgitation; and two had isolated stenosis. The transfemoral access was used in six cases, and the transapical access in one case. Implanted devices included Sapien XT (n = 5) and CoreValve (n = 2) prostheses. Procedural success was achieved in six (85.7%) cases. After the procedure, the mean gradient decreased from 38.2 ± 9.6 mmHg to 20.9 ± 5.9 mmHg, and the valve area increased from 1.2 ± 0.4 cm 2 to 1.5 ± 0.5 cm 2 . After 1 year, there were no deaths and no other significant adverse outcomes; 80% of patients were in NYHA functional class I/II. The transvalvular gradients and valve area remained unchanged in this period. Conclusions The valve-in-valve procedure was effective in most high-risk surgical patients with bioprosthesis dysfunction. When performed in well-selected patients, it results in satisfactory clinical and hemodynamic outcomes.

2-Year Outcomes in Patients Undergoing Surgical or Self-Expanding Transcatheter Aortic Valve Replacement

BackgroundThe U.S. pivotal trial for the self-expanding valve found that among patients with severe aortic stenosis at increased risk for surgery, the 1-year survival rate was 4.9 percentage points higher in patients treated with a self-expanding transcatheter aortic valve bioprosthesis than in those treated with a surgical bioprosthesis. ObjectivesLonger-term clinical outcomes were examined to confirm if this mortality benefit is sustained. MethodsPatients with severe aortic stenosis who were at increased surgical risk were recruited. Eligible patients were randomly assigned in a 1:1 ratio to transcatheter aortic valve replacement with the self-expanding transcatheter valve (transcatheter aortic valve replacement [TAVR] group) or to aortic valve replacement with a surgical bioprosthesis (surgical group). The 2-year clinical and echocardiographic outcomes were evaluated in these patients. ResultsA total of 797 patients underwent randomization at 45 centers in the United States. The rate of 2-year all-cause mortality was significantly lower in the TAVR group (22.2%) than in the surgical group (28.6%; log-rank test p < 0.05) in the as-treated cohort, with an absolute reduction in risk of 6.5 percentage points. Similar results were found in the intention-to-treat cohort (log-rank test p < 0.05). The rate of 2-year death or major stroke was significantly lower in the TAVR group (24.2%) than in the surgical group (32.5%; log-rank test p = 0.01). ConclusionsIn patients with severe aortic stenosis who are at increased surgical risk, the higher rate of survival with a self-expanding TAVR compared with surgery was sustained at 2 years. (Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve Replacement; NCT01240902)

Transcatheter aortic valve-in-valve implantation for patients with degenerative surgical bioprosthetic valves.

Bioprosthetic tissue valves are increasingly utilized during surgical aortic valve replacement. These valves have limited durability and many fail with time, resulting in stenosis, regurgitation, or both. Repeat cardiac surgery has been the standard of care for patients with failed bioprostheses. Transcatheter valve implantation inside failed surgically implanted bioprostheses (valve-in-valve) is a new less invasive alternative to repeat surgery. We review the potential and challenges of valve-in-valve implantation in patients with failing surgical aortic bioprostheses.

Valve-in-valve procedure: importance of the anatomy of surgical bioprostheses

Transcatheter aortic valve implantation is an accepted and established alternative to surgical aortic valve replacement for patients with severe symptomatic aortic valve stenosis and multiple comorbidities that would make open surgery a high-risk option. It has also evolved as a suitable treatment option for degenerative surgical heart valve disease, with considerable experience in the aortic and mitral positions. To enable a successful procedure, avoiding malposition, valve embolization and coronary obstruction, clinicians should be familiar with the design, fluoroscopic appearances and implantation technique of the degenerated surgical bioprosthetic valve in situ, as well as its compatibility with currently available transcatheter valves.

Transcatheter heart valve failure: a systematic review.

A comprehensive description of transcatheter heart valve (THV) failure has not been performed. We undertook a systematic review to investigate the aetiology, diagnosis, management, and outcomes of THV failure. The systematic review was performed in accordance with the PRISMA guidelines using EMBASE, MEDLINE, and Scopus. Between December 2002 and March 2014, 70 publications reported 87 individual cases of transcatheter aortic valve implantation (TAVI) failure. Similar to surgical bioprosthetic heart valve failure, we observed cases of prosthetic valve endocarditis (PVE) (n = 34), structural valve failure (n = 13), and THV thrombosis (n = 15). The microbiological profile of THV PVE was similar to surgical PVE, though one-quarter had satellite mitral valve endocarditis, and surgical intervention was required in 40% (75% survival). Structural valve failure occurred most frequently due to leaflet calcification and was predominantly treated by redo-THV (60%). Transcatheter heart valve thrombosis occurred at a mean 9 ± 7 months post-implantation and was successfully treated by prolonged anticoagulation in three-quarters of cases. Two novel causes of THV failure were identified: late THV embolization (n = 18); and THV compression (n = 7) following cardiopulmonary resuscitation (CPR). These failure modes have not been reported in the surgical literature. Potential risk factors for late THV embolization include low prosthesis implantation, THV undersizing/underexpansion, bicuspid, and non-calcified anatomy. Transcatheter heart valve embolization mandated surgery in 80% of patients. Transcatheter heart valve compression was noted at post-mortem in most cases. Transcatheter heart valves are susceptible to failure modes typical to those of surgical bioprostheses and unique to their specific design. Transcatheter heart valve compression and late embolization represent complications previously unreported in the surgical literature.