Valve-in-valve transcatheter aortic valve implantation into a novel, sutureless bioprosthesis: technical considerations
Consult this article published in the EuroIntervention Journal by Martin Andreas, et al. on technical considerations for valve-in-valve transcatheter aortic valve implantation into a novel, sutureless bioprosthesis.
Assessment of structural valve deterioration of transcatheter aortic bioprosthetic balloon-expandable valves using the new European consensus definition
Durability of transcatheter aortic bioprosthetic valves remains a major issue. Standardised definitions of deterioration and failure of bioprosthetic valves have recently been proposed. The aim of this study was to assess structural transcatheter valve deterioration (SVD) and bioprosthetic valve failure (BVF) using these new definitions.
Fluoroscopic identification of stented bioprostheses
Surgical aortic valve replacement remains the therapy of choice in the majority of patients with aortic stenosis. This section includes the device design along with its radiological/fluoroscopic appearance focussing on how this correlates with the implanted valve, as transcatheter aortic valve implantation is performed under fluoroscopic guidance.
Recognising the fluoroscopic appearance of a specific valve design, whether in providing a more complete understanding of the failing valve or in the choice and implantation for the valve-in-valve intervention itself, is a critical step in the overall success of the procedure.
Failure modes of surgical bioprostheses
With the increased use of surgical bioprosthetic valves and an ageing population, today’s clinician will inevitably be confronted with cases of bioprosthesis failure. While newer devices have much improved durability, being able to identify the nature and conditions that might lead to failure in these newer, as well as older devices, is critical. Knowledge of the basic construction and dimensions, radiographic identification, and potential failure modes of SAV bioprostheses is fundamental in understanding key principles involved in TAV-in-SAV implantation.
Bioprosthetic surgical aortic valve (SAV) construction
Two types of prosthetic valves are used for heart valve replacement surgery - mechanical or bioprosthetic. Mechanical valves have long-term durability, but require lifelong anticoagulation, with the risk of thrombosis, thromboembolism, or spontaneous bleeding and are therefore less than ideal, particularly in younger patients, pregnant patients, or patients in the developing world where close monitoring is difficult to ensure.
Bioprosthetic heart valves (BHVs) are constructed from porcine heart valves or bovine pericardium preserved with glutaraldehyde. Patients with BHVs do not require anticoagulation, but structural valve deterioration may occur, particularly in younger patients, necessitating replacement, where it is associated with a higher risk of mortality.
Stented valves are primarily constructed using a rigid radiopaque or radiolucent base ring from which a stent or frame is positioned as support for the valve leaflets. This ring is covered by a synthetic fabric or pericardium that protects the frame. A sewing ring is attached here and the three stent posts rise at a right angle to support the valve leaflets which then serve as markers for positioning the transcatheter valves.
Biological stented prostheses are currently the main type of prosthetic valve used for aortic valve replacement with the ratio of bioprostheses to mechanical prostheses reversing itself over the last 15 years. Moreover, the total number of implanted stented bioprostheses has remained stable over the last few years despite competing procedures like stentless prostheses or transcatheter aortic valve implantation.
How would you treat these challenging cases in your lab?
Right atrium tunnel, percutaneous mitral valve-in-valve implantation with S3 prosthesis or a rare case of aortitis with bilateral ostial coronary stenosis... learn more from this cases straight from the cathlab! GulfPCR-Gim 2018
EuroIntervention December print issue - Bringing clarity to the concerns of interventional cardiology
In carotid stenting, articles this month include one on a new-generation of mesh-covered stents. From the SCAAR registry, PCI outcomes with the Absorb BVS, another on differences between the Absorb BVS and the Mirage BRMS. In valvular treatments, an in vitro experiment using a novel synchronised diastolic injection method to reduce contrast volume during aortography for AR and a look at the low pacemaker rates following ACURATE neo THV implantation.
PCR London Valves 2017 - a dedicated EuroIntervention supplement on transcatheter heart valve therapies today
Fifteen years after the first percutaneous valve replacement and on the 40th anniversary of angioplasty, this supplement goes beyond history with articles on the state-of-the-art in aortic, mitral and tricuspid valve treatments. New devices, emerging data and the challenge of durability as treatment expands from high to lower risk patients.
Randomised Trials in percutaneous treatment for structural heart disease
On this page you will find a list of randomised trials in percutaneous treatment for structural heart disease, published in some of the world's top cardiology and interventional cardiology journals.