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Updated: Jan 20, 2026

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Bioprosthetic Valve Fracture for Valve-in-Valve Transcatheter Aortic Valve Replacement: Rationale, Patient Selection,
Mary Rodriguez Ziccardi1, Elliott M Groves2
1Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 South Wood Street Suite 920S, Chicago, IL 60612, USA.
Abstract:
Patient-prosthesis mismatch (PPM) is common after surgical valve aortic replacement. A significant percentage of patients with a small annulus have moderate to severe PPM. The outcomes for patients with larger effective orifice areas and lower gradients are better than for patients with PPM. With the advent of valve-in-valve TAVR, a degenerated surgical bioprosthesis can be treated with a percutaneous approach. However, the issue of PPM cannot be overcome by simply implanting a new valve. The technique of bioprosthetic valve fracture was therefore developed. This allows for implantation of a fully expanded transcatheter valve and results in a large effective orifice.
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