Management of failing bioprosthesis in elderly patients who have undergone transcatheter aortic valve replacement

Long-term Transcatheter Aortic Valve Durability

Transcatheter aortic valve implantation (TAVI) has become the standard of care for high-risk and inoperable surgical patients and a valid alternative to surgery for low- and intermediate-risk patients with severe, symptomatic aortic stenosis. It is increasingly being used for younger, lower-risk patients, so it is important to ensure the durability for long-term transcatheter aortic valves. The lack of standard definitions of structural valve degeneration (SVD) had made comparison among studies on prosthetic valve durability problematic. The 2017 standardised definitions of SVD by the European Association of Percutaneous Cardiovascular Intervention), the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery, and the 2018 definitions by the Valve In Valve International Data group, has generated an increased uniformity in evaluations. This article examines the potential mechanisms and rates of SVD of transcatheter bioprostheses and the role of redo TAVI as a treatment option.

Fulminant Presentation of a Failed TAVR Valve: Successful Revision with a Transcatheter Approach - Case Report and Review of the Literature

Transcatheter Aortic Valve Replacement (TAVR) has evolved as a strategy for managing aortic stenosis in a growing proportion of patients considered at high or intermediate surgical risk. Though early data has demonstrated excellent durability and life span of transcatheter valves up to five years, there is an absence of case based studies in the literature regarding transcatheter valve failure after TAVR, and outcomes of subsequent redo TAVR Valve-in-Valve (VIV) procedures. We report here a successful case of emergent, catheter-based treatment for severe, highly symptomatic valve in valve restenosis of a 5 year old Sapien valve.

Management of bioprosthetic cardiac valve thrombosis

Valvular thrombosis is a known complication of bioprosthetic valve replacement that usually occurs within a year of implantation. Four-dimensional computed tomography is quickly becoming the gold standard to directly visualize thrombus. Current guidelines for prophylaxis include aspirin for all bioprosthetic valve replacements, dual antiplatelet therapy for aortic valves, and anticoagulation for mitral valves. However, new trials have suggested single-agent antiplatelet therapy or anticoagulation for treatment of bioprosthetic valve thrombosis. Three cases are presented that illustrate the use of anticoagulants and new techniques for detecting thrombosis on imaging.

Degeneration of prosthesis after transcatheter aortic valve implantation

With the expanding indication of transcatheter aortic valve implantation (TAVI) to younger, lower risk population, transcatheter aortic valve (TAV) long-term durability is becoming an emerging issue to face with. Recently, the standardization of structural valve deterioration (SVD) definition by a join committee of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) has permitted to evaluate for the first time the rates of TAV durability with comparable endpoint. A few studies reporting on structural valve dysfunction (SVD) after TAVI up to 8 years using these standardized criteria have found very low rates of valve deterioration, thus supporting the adoption of TAVI treatment even for younger patients. For patients showing SVD at follow-ups, the VIVID (Valve-in-Valve International Data) group recently proposed an algorithm for their management. Re-do TAVI seems to be a safer and valid alternative to re-do surgery for symptomatic patients. This article review will go through the current evidence of TAV durability, describing the types of failure and strategies of treatment.