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Transcatheter Aortic Valve Replacement for Structural Valve Deterioration After Aortic Valve Neocuspidization
Natsuko Satomi1, Masaki Miyasaka1,2, Yusuke Enta1
1Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan.
Summary
Transcatheter aortic valve replacement (TAVR) is feasible for structural valve deterioration (SVD) after aortic valve neocuspidization (AVNeo). Careful planning is needed to avoid complications like deep implantation or annulus rupture.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Biomaterials Science
Background:
- Limited evidence exists on structural valve deterioration (SVD) following aortic valve neocuspidization (AVNeo).
- Transcatheter aortic valve replacement (TAVR) presents a less invasive alternative, but its applicability in this context is not well-established.
Purpose of the Study:
- To characterize SVD in patients who previously underwent AVNeo.
- To evaluate the feasibility and outcomes of TAVR in patients with SVD after AVNeo.
Main Methods:
- Retrospective analysis of 11 patients who underwent TAVR for SVD post-AVNeo.
- Categorization of patients into aortic stenosis (AS-SVD) and aortic regurgitation (AR-SVD) groups.
- Assessment of procedural success, complications, and anatomical parameters.
Main Results:
- The AS-SVD group had a shorter interval from AVNeo to TAVR and a smaller aortic annulus area compared to the AR-SVD group.
- TAVR achieved 91% technical success. No coronary obstruction occurred despite concerns about long leaflets.
- Complications included one case of second valve implantation, two instances of new conduction disturbance, and one aortic contained rupture.
Conclusions:
- Observed rapid progression of AS-SVD and later onset of AR-SVD suggest a need for further research into AVNeo durability.
- TAVR is a feasible treatment option for SVD after AVNeo.
- Precautions for coronary obstruction may not be essential; accurate CT-based basal ring determination is crucial for optimal TAVR outcomes.
Keywords:
aortic valve neocuspidizationcoronary obstructionstructural valve degenerationtranscatheter aortic valve replacementMore Related Videos
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