Redo surgical aortic valve replacement for prosthetic valve valve-in-valve dysfunction

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Transcatheter aortic valve replacement (TAVR) is a primary treatment for severe aortic stenosis, especially in patients with comorbidities.
• The valve-in-valve (ViV) procedure uses TAVR to treat failing bioprosthetic valves.
• TAVR implantation within small bioprosthetic valves (<23 mm) may predispose to delayed prosthetic valve dysfunction.

Observation:

• A 76-year-old female patient underwent TAVR as a valve-in-valve procedure 5 years after initial aortic valve replacement and coronary artery bypass grafting.
• The patient presented with symptoms of prosthetic valve dysfunction 3 years post-ViV procedure.
• A late explant of the ViV prosthesis was performed, revealing specific structural changes.

Findings:

• The explanted valve showed signs of significant wear and tear, consistent with delayed dysfunction.
• Analysis of the explanted valve provides insights into the biomechanical stresses and failure modes in TAVR-ViV procedures within small bioprostheses.
• Histopathological examination confirmed tissue degeneration and calcification contributing to valve failure.

Implications:

• This case highlights the potential for late complications following TAVR-ViV in small bioprosthetic valves.
• Understanding these failure mechanisms is crucial for optimizing patient selection and procedural techniques for TAVR-ViV.
• Further research is warranted to develop strategies to mitigate the risk of delayed dysfunction in TAVR-ViV procedures, particularly in smaller valve sizes.