Transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic and mitral valves – an update on indications, techniques, and clinical results

ABSTRACT

Introduction: Aortic and mitral bioprosthesis are the gold standard treatment to replace a pathological native valve. However, bioprostheses are prone to structural valve degeneration, resulting in limited long-term durability. During the past decade, the implantation of transcatheter stent-valves within degenerated aortic and mitral bioprostheses, (the so-called ‘valve-in-valve’ procedure), represents a valid alternative to redo surgery in patients with high-risk surgical profiles.

Areas covered: We reviewed the clinical outcomes and the procedural details of transcatheter aortic and mitral valve-in-valve series according to current published literature and include a practical guide for valve sizing and stent-valve positioning and strategies to prevent complications.

Expert opinion: In both aortic and mitral positions meticulous planning is fundamental in these procedures to avoid serious complications including patient prosthesis mismatch, coronary obstruction and left ventricular outflow tract obstruction.

KEYWORDS:

• Transcatheter valve replacement
• aortic valve-in-valve replacement
• mitral valve-in-valve replacement
• redo cardiac surgery
• high-risk patients
• degenerated bioprosthesis

Article highlights

• V-in-V in moderate and high-risk elderly patients for degenerated bioprosthesis in the aortic and mitral position is a safe procedure.

• Percutaneous access route, correct valve sizing, alignment and positioning are crucial steps during V-in-V procedures.

• Risks related to the aortic V-in-V procedures are the prosthesis mismatch and the coronary ostia occlusion whereas for mitral V-in-V procedures are prosthesis mismatch and left ventricular outflow tract obstruction.

• The new valve design, TAVR-in-TAVR, and transcatheter valve durability are new challenges to face over the next years.

Declaration of interest

E Ferrari is a consultant for Edwards Lifesciences and received educational grants from Edwards Lifesciences and Medtronic. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.