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Chatfield AG, Cheung A, Akodad M, Chuang A, Besola L, Sellers S, Wood DA, Sathananthan J, Webb J. Transcatheter solutions for transcatheter aortic valve replacement dysfunction: is redo transcatheter aortic valve replacement a durable option? Ann Cardiothorac Surg 2021; 10:571-584. [PMID: 34733686 DOI: 10.21037/acs-2021-tviv-85] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/18/2021] [Indexed: 11/06/2022]
Abstract
As transcatheter aortic valve replacement (TAVR) expands into a younger and lower risk cohort of patients, many important clinical questions are raised, including the one of overall valve durability. Bioprosthetic valve dysfunction (BVD) is a complex clinical issue, of which structural valve deterioration (SVD) is a subcategory. Similar to surgical bioprosthesis, transcatheter heart valves (THVs) can fail over the years however, data on long-term THVs durability is lacking, especially in the lower risk cohort. Surgical explant with open aortic surgery or a second THV, described as redo-TAVR, are feasible options when the first THV fails. However long-term data in these patients is even more limited. Important clinical considerations such as the mechanism(s) of THV dysfunction, the type and timing of the second procedure must be carefully considered. There are also inherently important clinical concerns regarding redo-TAVR, such as coronary access and higher post procedure gradients. In the present keynote lecture, we review the diagnosis of THV dysfunction and transcatheter options available when SVD occurs.
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Affiliation(s)
- Andrew G Chatfield
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Anson Cheung
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Mariama Akodad
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Anthony Chuang
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Laura Besola
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie Sellers
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - David A Wood
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John Webb
- Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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Geicu L, Busuttil O, D’Ostrevy N, Pernot M, Benali W, Labrousse L, Modine T. Updates on the Latest Surgical Approach of the Aortic Stenosis. J Clin Med 2021; 10:5140. [PMID: 34768660 PMCID: PMC8584939 DOI: 10.3390/jcm10215140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Over the last twenty years, we marked significant progresses in the field of tissue engineering and the development of new aortic valve structural and delivery systems. These continuous iterations on the field, have completely changed the surgical indications and approaches for AVR. Nowadays, therapeutic decisions are endorsed by international guidelines; however, new technical advances need a new integrated approach. The clinical scenarios issued from the interaction between the Guidelines and the newest approaches and technologies are regularly on debate by the Heart Team. We will present some of our most encountered situations and the pattern of our therapeutic decisions. To easily navigate through Guidelines and clinical scenarios, we reported in this review a simplified and easy to use Clinical decision-making algorithm that may be a valuable tool in our daily practice.
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Affiliation(s)
- Lucian Geicu
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal University, Montreal, QC H1T 1C8, Canada; (L.G.); (W.B.)
| | - Olivier Busuttil
- Unité Médico-Chirurgicale, Hôpital Haut Lévêque, CHU de Bordeaux, CEDEX, 33604 Pessac, France; (O.B.); (M.P.); (L.L.)
| | - Nicolas D’Ostrevy
- Cardiac Surgery Department, CHU de Clermont Ferrand, 63003 Clermont Ferrand, France;
| | - Mathieu Pernot
- Unité Médico-Chirurgicale, Hôpital Haut Lévêque, CHU de Bordeaux, CEDEX, 33604 Pessac, France; (O.B.); (M.P.); (L.L.)
| | - Walid Benali
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal University, Montreal, QC H1T 1C8, Canada; (L.G.); (W.B.)
| | - Louis Labrousse
- Unité Médico-Chirurgicale, Hôpital Haut Lévêque, CHU de Bordeaux, CEDEX, 33604 Pessac, France; (O.B.); (M.P.); (L.L.)
| | - Thomas Modine
- Unité Médico-Chirurgicale, Hôpital Haut Lévêque, CHU de Bordeaux, CEDEX, 33604 Pessac, France; (O.B.); (M.P.); (L.L.)
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