Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan;13(1):20-26.
doi: 10.15420/icr.2017:29:1.

Bioprosthetic Valve Fracture During Valve-in-valve TAVR: Bench to Bedside

John T Saxon  1   2 , Keith B Allen  1   2 , David J Cohen  1   2 , Adnan K Chhatriwalla  1   2
Affiliations

Bioprosthetic Valve Fracture During Valve-in-valve TAVR: Bench to Bedside

John T Saxon et al. Interv Cardiol. 2018 Jan.

Abstract

Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) has been established as a safe and effective means of treating failed surgical bioprosthetic valves (BPVs) in patients at high risk for complications related to reoperation. Patients who undergo VIV TAVR are at risk of patient-prosthesis mismatch, as the transcatheter heart valve (THV) is implanted within the ring of the existing BPV, limiting full expansion and reducing the maximum achievable effective orifice area of the THV. Importantly, patient-prosthesis mismatch and high residual transvalvular gradients are associated with reduced survival following VIV TAVR. Bioprosthetic valve fracture (BVF) is as a novel technique to address this problem. During BPV, a non-compliant valvuloplasty balloon is positioned within the BPV frame, and a highpressure balloon inflation is performed to fracture the surgical sewing ring of the BPV. This allows for further expansion of the BPV as well as the implanted THV, thus increasing the maximum effective orifice area that can be achieved after VIV TAVR. This review focuses on the current evidence base for BVF to facilitate VIV TAVR, including initial bench testing, procedural technique, clinical experience and future directions.

Keywords: Transcatheter aortic valve replacement; aortic stenosis; bioprosthetic valve fracture; patient–prosthesis mismatch; valve-in-valve TAVR.

PubMed Disclaimer

Conflict of interest statement

Disclosure: Dr. Chhatriwalla receives research and clinical trial support from, acts as a proctor of, and is on the speakers bureau of Medtronic, Edwards Lifesciences and St. Jude Medical. Dr. Cohen receives research and clinical trial support from Medtronic, St. Jude Medical, and Edwards Lifesciences. Dr. Allen receives research support from Abbott Medical and Edwards Lifesciences, and is on the speakers bureau of Edwards Lifesciences and Medtronic. Dr. Saxon has no disclosures.

Figures

Figure 1:
Figure 1:. Technique of High-pressure Balloon Inflation to Perform Bioprosthetic Valve Fracture
Figure 2:
Figure 2:. Fractured 21 mm Mitroflow Bioprosthetic Valve
Figure 3:
Figure 3:. A: Baseline Appearance of 23 mm Magna BPV after Deployment of 26 mm Medtronic Evolut R THV. B: Initial Balloon Inflation During BVF. C: Appearance of BPV and Balloon after BPV Ring Fracture. Note the Visible Release of the Balloon Waist and Expansion of BPV Compared to (B). D: Final Appearance after VIV TAVR and BVF
Figure 4:
Figure 4:. A: Baseline Haemodynamics Prior to VIV TAVR. The Mean Gradient was Measured at 39 mmHg and the Mean EOA was Calculated at 0.7 cm2. B: Post-VIV TAVR. The Mean Gradient was Measured at 25 mmHg and the EOA was Calculated at 1.2 cm2. C: Post-BVF. The Final Mean Gradient was Measured at 3 mmHg and the EOA was Calculated at 1.7 cm2
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Adams DH, Popma JJ, Reardon MJ. Transcatheter aortic- valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;371:967–8. doi: 10.1056/NEJMc1408396. - DOI - PubMed
    1. Leon MB, Smith CR, Mack M et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597–607. doi: 10.1056/NEJMoa1008232. - DOI - PubMed
    1. Smith CR, Leon MB, Mack MJ et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98. doi: 10.1056/NEJMoa1103510. - DOI - PubMed
    1. Leon MB, Smith CR. Transcatheter aortic-valve replacement. N Engl J Med. 2016;375:700–1. - PubMed
    1. Balsam LB, Grossi EA, Greenhouse DG et al. Reoperative valve surgery in the elderly: predictors of risk and long-term survival. Ann Thorac Surg. 2010;90:1195–200. doi: 10.1016/j.athoracsur.2010.04.057. - DOI - PubMed