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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
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Transcatheter valve-in-valve interventions after aortic root replacement: A systematic review
Massimo Baudo1,2, Besart Cuko3, Julien Ternacle3
1Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA.
Summary
Transcatheter valve-in-valve (ViV-TAVI) is a viable option for structural valve deterioration after aortic root replacement (ARR). Careful consideration of patient-specific factors and surgical history is crucial for successful outcomes.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Prosthetic Heart Valves
Background:
- Structural valve deterioration is a known complication following aortic root replacement (ARR).
- Transcatheter valve-in-valve (ViV-TAVI) intervention presents a potential treatment option for these patients.
- Outcomes and technical challenges of ViV-TAVI after ARR require further elucidation.
Approach:
- A systematic review was conducted, searching multiple databases (PubMed, ScienceDirect, SciELO, DOAJ, Cochrane Library) up to September 2023.
- Included studies reported transcatheter interventions in patients with prior ARR, encompassing all replacement techniques.
- Data from 86 patients across 31 articles were analyzed.
Key Points:
- The average time from ARR to reintervention was 11 years, with homografts being the most common ARR type.
- Aortic regurgitation was the primary indication for intervention (69.7%).
- Postoperative complications were infrequent, including permanent pacemaker implantation (7.0%), second ViV-TAVI (4.7%), device migration (3.5%), and stroke (1.2%).
Conclusions:
- ViV-TAVI is a feasible option for selected patients with deteriorated aortic root replacement, despite unique technical challenges.
- Pre-procedural assessment, including computed tomography, is essential for addressing these challenges.
- Patients with prior ARR often have high surgical risk, making minimally invasive options like ViV-TAVI attractive.
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