scholarly journals New Challenging Scenarios in Transcatheter Aortic Valve Implantation: Valve-in-valve, Bicuspid and Native Aortic Regurgitation

2021 ◽  
Vol 16 ◽  
Author(s):  
Sandra Santos-Martínez ◽  
Ignacio J Amat-Santos
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Bicuspid Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Current Evidence ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Valve In Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) is the most frequently performed structural technique in the field of interventional cardiology. Initially, this procedure was only used in patients with severe symptomatic aortic stenosis and prohibitive risk. Now, barely one decade after its introduction, TAVI indications extend to low- and intermediate-risk patients. Despite these advances, several challenging scenarios are still on the periphery of the evidence base for TAVI. These include valve-in-valve procedures, lower-risk patients with bicuspid aortic valve and the treatment of pure aortic regurgitation. Whereas the valve-in-valve indication has expanded rapidly, evidence for the use of TAVI compared with conventional surgery for bicuspid aortic valve is limited, including the best choice of device should TAVI be used. Evidence for TAVI in pure aortic regurgitation is still anecdotal because of suboptimal outcomes. Operators worldwide have described variations in the TAVI procedural technique to achieve commissural alignment and to minimise the rate of pacemaker use through cusp overlap implantation. In light of the potential clinical benefits, this may also be an area of further development. This review aims to discuss the current evidence available supporting the use of TAVI for these new indications.

Transcatheter aortic valve implantation in low-risk patients: A case of rational over exuberance. The time is not now

2021 ◽  
pp. 021849232110185
Author(s):  
Manoraj Navaratnarajah ◽  
Suvitesh Luthra ◽  
Sunil Ohri
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Pacemaker Implantation ◽  
Low Risk ◽  
Current Evidence ◽  
Paravalvular Leak ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Background Review of evidence and concerns, relating to extension of transcatheter aortic valve implantation usage to low–risk patients. Methods Comprehensive literature review was conducted identifying articles relating to transcatheter aortic valve implantation. Results Transcatheter aortic valve implantation is effective in patients with aortic stenosis. Currently, long-term durability and cost-effectiveness are unproven, anticoagulation requirement undefined, permanent pacemaker implantation and paravalvular leak rates higher than following surgical aortic valve replacement. Conclusions Current evidence supporting transcatheter aortic valve implantation usage in low-risk patients is insufficient. Extending use now, to this large young patient population is premature, and should be delayed.

Transcatheter Aortic Valve Implantation in Bicuspid Aortic Valve Pathology: Current Evidence and Technical Challenges

2021 ◽  
Vol 39 ◽  
Author(s):  
Andreas Schaefer ◽  
◽  
Lenard Conradi ◽  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Current Evidence ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Technical Challenges ◽  
Valve Pathology ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) is an established therapy for severe symptomatic aortic valve stenosis (AS) in patients at high and intermediate risk for surgical aortic valve replacement (SAVR). Current evidence also suggests at least non-inferiority of TAVI in low-risk patients compared to SAVR. However, there are special subsets of patients and anatomical circumstances in which TAVI is traditionally considered a suboptimal treatment strategy due to procedure inherent increased risks (e.g., rupture of cardiac chambers in patients with severe calcifications of the left ventricular outflow tract, valve migration in very large aortic annuli). One of these special subsets is bicuspid AS. Bicuspid aortic valve disease is the most common congenital heart defect and most frequent reason for AS in patients <70 years of age. Bicuspid aortic valve pathology is characterized by special anatomical complexities like asymmetrical cusp proportion and calcium distribution, a more pronounced annular ellipticity compared to tricuspid aortic valves and concomitant dilation of the thoracic aorta. These factors have led physicians to traditionally indicate TAVI more reluctantly in those patients in the past. In this article, current evidence for TAVI for bicuspid AS is discussed and technical challenges are highlighted.

scholarly journals Valve-in-valve transcatheter aortic valve implantation with fracturing of a failed small surgical aortic bioprosthesis: a case report

2020 ◽  
Author(s):  
Matjaz Bunc ◽  
Miha Cercek ◽  
Tomaz Podlesnikar ◽  
Simon Terseglav ◽  
Klemen Steblovnik
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Ex Vivo ◽  
Bioprosthetic Valve ◽  
Heart Team ◽  
Transcatheter Aortic Valve ◽  
Patient Prosthesis Mismatch ◽  
Valve In Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Failure of a small surgical aortic bioprosthesis represents a challenging clinical scenario with valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) often resulting in patient-prosthesis mismatch. Bioprosthetic valve fracture (BVF) performed as a part of the ViV TAVI has recently emerged as an alternative approach with certain types of surgical bioprostheses. Case summary An 81-year-old woman with a history of three surgical aortic valve procedures presented with heart failure. Aortic bioprosthesis degeneration with severe stenosis and moderate regurgitation was found. The patient was deemed a high-risk surgical candidate and the heart team decided that ViV TAVI was the preferred treatment option. Due to the very small 19 mm stented surgical aortic bioprosthesis Mitroflow 19 mm (Sorin Group, Italy) we decided to perform BVF as a part of ViV TAVI to prevent patient-prosthesis mismatch. Since this was the first BVF procedure in our centre, an ex vivo BVF of the same kind of bioprosthetic valve was performed first. Subsequently, successful BVF with implantation of Evolut R 23 mm (Medtronic, USA) self-expandable transcatheter valve was performed. Excellent haemodynamic result was achieved and no periprocedural complications were present. The patient had an immediate major improvement in clinical status and remains asymptomatic after 6 months. Discussion Bioprosthetic valve fracture together with ViV TAVI is a safe and effective emerging technique for treatment of small surgical aortic bioprosthesis failure. Bioprosthetic valve fracture allows marked oversizing of implanted self-expandable transcatheter aortic valves, leading to excellent haemodynamic and clinical results. An ex vivo BVF can serve as an important preparatory step when introducing the new method.

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