Management of Failed Bioprosthetic Aortic Valves: Mitigating Complications and Optimizing Outcomes

• Type of Material: Article
• Authors: Elizabeth L. Norton, Emory University; Alison Ward, Emory University; Adam Greenbaum, Emory University; Kendra Grubb, Emory University
• Language: English
• Date: 2022-09-02
• Publisher: WILEY-HINDAWI
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Elizabeth L. Norton et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1155/2022/9737245
• Title of Journal or Parent Work: JOURNAL OF INTERVENTIONAL CARDIOLOGY
• Volume: 2022
• Start Page: 9737245
• End Page: 9737245
• Keywords: HYPOPLASIA; Cardiac & Cardiovascular Systems; Science & Technology; INSIGHTS; Life Sciences & Biomedicine; Cardiovascular System & Cardiology; MISMATCH; IMPLANTATION; PREDICTORS; INCISION; ENLARGEMENT; TRANSCATHETER; REPLACEMENT; CLINICAL-OUTCOMES
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

The use of bioprosthetic prostheses during surgical aortic valve replacements has increased dramatically over the last two decades, accounting for over 85% of surgical implantations. Given limited long-term durability, there has been an increase in aortic valve reoperations and reinterventions. With the advent of new technologies, multiple treatment strategies are available to treat bioprosthetic valve failure, including valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR). However, ViV TAVR has an increased risk of higher gradients and patient prosthesis mismatch (PPM) secondary to placing the new valve within the rigid frame of the prior valve, especially in patients with a small surgical bioprosthesis in situ. Bioprosthetic valve fracture allows for placement of a larger transcatheter valve, as well as a fully expanded transcatheter valve, decreasing postoperative gradients and the risk of PPM.