Tricuspid valve-in-valve implantation for failing bioprosthetic valves: an evolving standard of care

Redo surgery for bioprosthetic tricuspid valve failure is associated with high morbidity and mortality. In recent years, transcatheter tricuspid valve-in-valve (VIV) therapy utilizing ballon-expandable transcatheter valves has become available. The tricuspid Valve-in-Valve International Data (VIVID) registry initial results represent the largest experience with tricuspid VIV therapy, demonstrating high procedural success rates with low 30 days mortality and excellent survival free of repeat tricuspid intervention in 1 year. Although longer clinic and hemodynamic follow-up will be needed to fully understand the role of this therapy, these data support the safety, feasibility and beneficial effects of tricuspid VIV therapy. For patients with bioprosthetic tricuspid valve failure, tricuspid VIV is likely to become a first-line treatment option.

Transcatheter valve-in-valve or valve-in-ring implantation with a novel balloon-expandable device in patients with bioprosthetic left side heart valves failure: 1-year follow-up from a multicenter experience

BACKGROUND

Transcatheter aortic and mitral valve-in-valve (ViV) or valve-in-ring (ViR) implantation into failed bioprosthetic heart valves (BHVs) or rings represents an appealing, less invasive, treatment option for patients at high surgical risk. Nowadays, few data have been reported on the use of balloon-expandable Myval (Meril Life Science, Vapi, India) transcatheter heart valve (THV) for the treatment of degenerated BHVs or rings. We aimed at evaluating the early and mid-term clinical outcomes of patients with left side heart bioprosthesis deterioration treated with transcatheter ViV/ViR implantation using Myval THV.

METHODS

97 consecutive patients with symptomatic, severe aortic(n=33) and mitral(n=64) BHVs/ring dysfunction underwent transcatheter aortic ViV and mitral ViV/ViR implantation with Myval THV.

RESULTS

Technical success was achieved in 95 (98%) of the patients. Two cases of acute structural trans-catheter mitral ViV/ViR dysfunction requiring a second THV implantation were reported. At 30-day, a significant reduction in prosthetic trans-valvular pressure gradients and increase in valve areas were seen following both aortic and mitral ViV/ViR implantation. Overall survival at 15 months (IQR 8-21) was 92%. Patients undergoing mitral ViV/ViR had a relatively worse survival compared with those undergoing aortic ViV implantation (89% vs. 97% respectively; HR:2.7,CI:0.33-22.7;p=0.34). At longest follow-up available a significant improvement in NYHA functional class I and II was observed in patients with aortic and mitral ViV/ViR implantation(93.8% and 92.1%).

CONCLUSIONS

Despite high surgical risk, transcatheter ViV/ViR implantation for failed left side heart bioprosthesis can be performed safely using Myval THV with a high success rate and low early and mid-term mortality and morbidity.

A systematic review and meta-analysis of the hemodynamics and outcomes of the Myval balloon-expandable valve in patients with severe aortic stenosis and with aortic regurgitation

Introduction

Transcatheter aortic valve implantation (TAVI) has been growing rapidly. We aim to evaluate the performance and outcomes of the Myval transcatheter heart valve (THV) in patients with severe aortic stenosis and its use in quantitative videodensimetry, transcatheter valve-in-valve (ViV), and non-calcified aortic regurgitation (NCAR).

Methods

A systematic search was done in PubMed, Scopus, Web of Science, Embase, and Cochrane from inception to October 2024. We used the relevant keywords to include studies that reported the outcomes of patients with severe aortic stenosis who underwent TAVI using the Myval THV and off-label usage in transcatheter ViV and NCAR. Data analysis was done using R software.

Results

A total of 29 studies were included in this study. The results of the mean aortic gradient at discharge, 30-day, one-year, and 2-year were 9.25 mmHg (95 % CI [8.20, 10.29]), 8.46 (95 % CI [7.57, 9.34]). 10.63 (95 % CI [9.12, 12.14]), and 7.2 (95 % CI [6.78, 7.63]), respectively. Additionally, the pooled percentages of patients with ≥ moderate aortic regurgitation were found in 1 % (95 % CI [1,2]) at discharge, 3 % (95 % CI [2,4]) at 30-day, 4 % (95 % CI [2,7]) at one-year follow-up and 5 % (95 % CI [3,8]) at 2-year. Furthermore, usage of the Myval THV in transcatheter ViV and NCAR led to a reduction in mean aortic gradient and incidence of aortic regurgitation, respectively.

Conclusion

The Myval THV showed good safety and efficacy outcomes in short- and long-term follow-ups following the TAVI. Also, it showed promising results during transcatheter ViV and NCAR.