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Review
. 2022 May 31:9:895477.
doi: 10.3389/fcvm.2022.895477. eCollection 2022.

Transcatether Aortic Valve Implantation to Treat Degenerated Surgical Bioprosthesis: Focus on the Specific Procedural Challenges

Cristina Aurigemma  1 , Francesco Burzotta  1   2 , Rocco Vergallo  1 , Piero Farina  1 , Enrico Romagnoli  1 , Stefano Cangemi  1   2 , Francesco Bianchini  1 , Marialisa Nesta  1 , Piergiorgio Bruno  1   2 , Domenico D'Amario  1 , Antonio Maria Leone  1 , Carlo Trani  1   2
Affiliations
Review

Transcatether Aortic Valve Implantation to Treat Degenerated Surgical Bioprosthesis: Focus on the Specific Procedural Challenges

Cristina Aurigemma et al. Front Cardiovasc Med. .

Abstract

Actually transcatheter aortic valve implantation within failed surgically bioprosthetic valves (VIV-TAVI) is an established procedure in patients at high risk for repeat surgical aortic valve intervention. Although less invasive than surgical reintervention, VIV-TAVI procedure offers potential challenges, such as higher rates of prosthesis-patient mismatch and coronary obstruction. Thus, optimal procedural planning plays an important role to minimize the risk of procedure complications. In this review, we describe the key points of a VIV-TAVI procedure to optimize outcomes and reduce the risk of procedure complications.

Keywords: cerebral embolization; coronary occlusion; degenerated surgical bioprosthesis; post procedural gradient; stentless aortic bioprosthesis; sutureless aortic bioprosthesis; valve in valve.

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Conflict of interest statement

FBu discloses to have been involved in advisory board meetings or having received speaker's fees from Abbott, Abiomed, Medtronic and Biotronic. CT discloses to have been involved in advisory board meetings or having received speaker's fees from Abbott, Abiomed, Medtronic and Biotronic. CA has been involved in advisory board activities by Abbott, Abiomed, Medtronic and Biotronic. AL discloses to receive speaking honoraria from St. Jude Medical/Abbott, Medtronic, Abiomed and from Bracco Imaging. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The key points of a VIV procedure to optimize outcomes and minimize the risk of operative complications.
Figure 2
Figure 2
True internal diameter (ID) of stented and stentless surgical aortic valves. In stented valves with porcine leaflets sutured inside (Epic) true ID is at least 2 mm < the stent ID. In stented valves with pericardial leaflets sutured inside (Perimount) true ID is at least 1 mm < the stent ID. In pericardial valves with leaflets sutured outside (Mitroflow) true ID is the same as the stent ID. In the stentless valves (Toronto), which do not possess a rigid stent frame, the true ID is always smaller than the labeled size, which corresponds to the root diameter.
Figure 3
Figure 3
Incidence of coronary obstruction. The incidence of coronary obstruction is four folders greater in TAVI for degenerative bioprosthetic valves compared to TAVI for native aortic valves. The risk of coronary obstruction is also correlated to the type of SHV. Indeed it is highest during VIV TAVI procedures for surgical bioprothesis designs intended to maximize effective aortic orifice area (such as “stented” bioprostheses that have externally mounted leaflets, and “stentless” surgical bioprostheses).
See this image and copyright information in PMC

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