Transcatheter aortic valve replacement (TAVR) is an established procedure for the treatment of patients with severe symptomatic aortic stenosis (AS) at prohibitive or high operative risk for conventional surgical valve replacement (sAVR), improving survival and quality of life. Since the introduction of TAVR, several reports have suggested that off-label use of TAVR for degenerated surgically inserted bio-prosthetic valves (valve-in-valve) is feasible and effective. However, unlike stented bio-prosthetic valves, a stentless valve has no rigid metallic ring for the anchoring of the new prosthesis and no visual landmarks to guide its positioning making such a procedure very demanding.
In this month’s Journal of Invasive Cardiology, we present an interesting case of Transfemoral Aortic Valve-in-Valve Implantation in a Degenerated Stentless Bioprosthetic Valve. Our case demonstrates that valve-in-valve replacement in stentless bioprothetic aortic valves is a feasible, however technically demanding, procedure and that TEE guidance in the absence of fluoroscopic landmarks is of paramount importance. For these reasons, Valve-in-Valve procedures should be undertaken only at experienced centers.
A selection of “Valve-in-Valve” articles available at http://www.invasivecardiology.com:
- 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.
- 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.