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Technical pitfalls and tips for the valve-in-valve procedure
1Cardiovascular Division, New York Presbyterian Hospital, Columbia University Medical Centre, New York, NY, USA.
Annals of Cardiothoracic Surgery
|October 25, 2017
Summary
Transcatheter aortic valve implantation (TAVI) offers a less invasive option for degenerated bioprosthetic surgical heart valves (SHV). Careful procedural planning, including patient selection and device choice, is crucial for successful valve-in-valve (VIV) procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Transcatheter aortic valve implantation (TAVI) is a key treatment for severe aortic stenosis.
- Degenerated bioprosthetic surgical heart valves (SHV) now represent a growing indication for TAVI, termed valve-in-valve (VIV).
- Commonly used devices include balloon-expandable and self-expandable transcatheter heart valves (THV).
Purpose of the Study:
- To outline critical procedural planning steps for aortic valve-in-valve (VIV) procedures.
- To highlight strategies for minimizing complications in VIV interventions.
- To emphasize the importance of accurate device sizing and patient selection.
Main Methods:
- Identification of the degenerated surgical heart valve (SHV), including model, size, and true internal diameter.
- Selection of the appropriate transcatheter heart valve (THV) based on SHV characteristics and procedural goals.
- Familiarization with fluoroscopic appearances of both SHV and THV for optimal positioning.
- Assessment of coronary obstruction risk using aortic root angiography or CT.
- Careful planning of the access route.
Main Results:
- Thorough procedural planning is essential for successful aortic valve-in-valve (VIV) procedures.
- Accurate determination of the surgical heart valve's true internal diameter is vital for selecting the correct transcatheter heart valve size.
- Understanding fluoroscopic landmarks aids in optimal device placement, influencing gradients and fixation.
- Risk stratification for coronary obstruction and meticulous access route planning are critical components.
Conclusions:
- Valve-in-valve (VIV) procedures in the aortic position require meticulous planning to ensure optimal outcomes.
- Key planning elements include accurate device sizing, understanding device behavior, assessing coronary access, and choosing the appropriate approach.
- Adherence to these planning steps can lead to efficient procedures with a reduced risk of complications.
