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Updated: Oct 14, 2025

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Bioprosthetic valve fracture: a practical guide.

Keith B Allen1, Adnan K Chhatriwalla1, John T Saxon1

  • 1Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA.

Annals of Cardiothoracic Surgery
|November 4, 2021
PubMed
Summary

Bioprosthetic valve fracture (BVF) and remodeling (BVR) improve transcatheter aortic valve replacement outcomes in patients with failed surgical valves. These techniques optimize transcatheter heart valve expansion and reduce gradients, especially in smaller valves.

Keywords:
Surgical aortic valve replacementbioprosthetic valve fracture (BVF)replacementtranscatheter aortic valvevalve in valve

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) treats failed surgical valves in high-risk patients.
  • Suboptimal transcatheter heart valve (THV) expansion and patient-prosthesis mismatch (PPM) are common in VIV TAVR, particularly with small surgical valves.

Purpose of the Study:

  • To describe patient selection, procedural planning, and technical insights for Bioprosthetic Valve Fracture (BVF) and Bioprosthetic Valve Remodeling (BVR).
  • To demonstrate how BVF and BVR facilitate optimal THV expansion and reduce transvalvular gradients in VIV TAVR.

Main Methods:

  • Utilizing high-pressure non-compliant balloon inflation to fracture or remodel the native bioprosthetic valve ring.
  • Application of these techniques during the VIV TAVR procedure.

Main Results:

  • BVF and BVR can overcome suboptimal THV expansion in VIV TAVR.
  • These methods effectively reduce residual transvalvular gradients, mitigating PPM.

Conclusions:

  • BVF and BVR are valuable adjuncts to VIV TAVR, improving procedural success and patient outcomes.
  • Optimal THV expansion and gradient reduction are achievable with these innovative techniques.