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Bioprosthetic Aortic Paravalvular Leak: Is Valve-in-Valve Another Solution?
Anwar Tandar1, David A Bull, Frederick G P Welt
1Division of Cardiovascular Medicine, University of Utah School of Medicine, 30 North 1900 East, Rm 4A100, Salt Lake City, UT 84132 USA. anwar.tandar@hsc.utah.edu.
The Journal of Invasive Cardiology
|January 4, 2017
Summary
Paravalvular leak (PVL) after aortic valve implantation is a rare but serious complication. A transcatheter aortic valve replacement (TAVR) valve-in-valve approach may offer an alternative for treating bioprosthetic PVL in the aortic position.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Paravalvular leak (PVL) is a potential complication following aortic and mitral valve replacement surgery, occurring in 2-17% of cases.
- Significant PVL can lead to serious consequences, necessitating intervention.
- Traditional management involves repeat surgical repair, which carries high risks for many patients.
Observation:
- Transcatheter valve replacement procedures show significant PVL rates of 6-8%.
- Percutaneous transcatheter approaches, including vascular plugs, have been used for PVL closure with variable success and technical challenges.
- Aortic position bioprosthetic PVL in high-risk patients presents a management dilemma.
Findings:
- Transcatheter aortic valve replacement (TAVR) using a valve-in-valve technique is explored as a novel treatment strategy.
- This approach may be particularly beneficial for patients deemed too high-risk for reoperation.
Implications:
- The valve-in-valve TAVR approach could offer a less invasive alternative for managing bioprosthetic paravalvular leaks.
- Further research is needed to establish the efficacy and safety of this transcatheter method for PVL treatment.
- This could expand treatment options for high-risk cardiac patients with PVL.
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