By Marat Fudim, MD
Transcatheter aortic valve replacement (TAVR) is an established alternative to surgical aortic valve replacement (SAVR) for the treatment of severe aortic stenosis in patients at high surgical risk, and is considered superior to medical management in patients who are deemed inoperable. Since the introduction of TAVR, several reports have suggested that off-label use of TAVR for failed surgically inserted bioprosthetic valves (valve-in-valve) is feasible and effective. However, to our knowledge there have not been any reports of valve-in-valve TAVR for hemodynamically unstable patients due to acute bioprosthetic valve failure.
Acutely failing bioprosthetic valves represent a clinical emergency and are exceedingly challenging given the paucity of therapeutic options. Oftentimes, these patients are not reoperative candidates due to clinical instability. In this months’s Journal of Invasive Cardiology, we present two cases of acute aortic bioprosthetic valve failure with cardiogenic shock treated with TAVR. These cases were characterized by hemodynamic instability with vasopressor dependence and (multiple) organ failure. Our two cases demonstrate that TAVR should be considered as a treatment option for unstable patients with bioprosthetic failure.
- Fudim M, Markley RR, Robbins MA. Transcatheter Aortic Valve Replacement for Aortic Bioprosthetic Valve Failure With Cardiogenic Shock. J INVASIVE CARDIOL 2013;25(11):625–626.
This month’s issue also features a thought-provoking commentary on the aforementioned paper:
- Shah N, Singla S, Deshmukh A, Sachdeva R. Can We Use Valve-In-Valve Transcatheter Aortic Valve Replacement in an Unstable Patient? J INVASIVE CARDIOL 2013;25(11):627.
A selection of “Valve-in-Valve” articles available at http://www.invasivecardiology.com:
- Yu Y, Vallely M, Ng MK. Valve-in-valve implantation for aortic annular rupture complicating transcatheter aortic valve replacement (TAVR). J Invasive Cardiol. 2013 Aug;25(8):409-10.
- Hanna BM, Rodés-Cabau J, Dahdah N. Percutaneous transcatheter valve-in-valve implantation with the balloon-expandable valve for the treatment of a dysfunctional tricuspid bioprosthetic valve – a pediatric case report. J Invasive Cardiol. 2013 Jun;25(6):310-2.
- Bekeredjian R, Chorianopoulos E, Katus HA. Successful transfemoral antegrade valve-in-valve implantation of a SAPIEN XT valve into a degenerated mitral valve prosthesis. J Invasive Cardiol. 2012 Apr;24(4):170-2.
- Dvir D, Assali A, Vaknin-Assa H, Sagie A, Shapira Y, Porat E, Kornowski R. Transcatheter aortic and mitral valve implantations for failed bioprosthetic heart valves. J Invasive Cardiol. 2011 Sep;23(9):377-81.
- Kefer J, Astarci P, Renkin J. Intracardiac echo imaging of a transfemoral aortic Edwards SAPIEN valve implantation in a degenerated bioprosthesis (valve-in-valve). J Invasive Cardiol. 2010 Jul;22(7):341-2.