Valve-in-valve transcatheter aortic valve replacement: the challenge of the next future

Abstract

In recent years, an increasing number of bioprostheses have been implanted, and in the near future more and more patients will be candidates for reoperation due to structural deterioration of the valve. Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become a safe and effective alternative to surgery and is currently approved for higher-risk, inoperable patients. From the most recent studies, early mortality has decreased and improvements in symptoms and quality of life of treated patients have been documented. ViV TAVR is a complex procedure that can present many pitfalls and therefore must be performed in high volume centers and with experienced staff because the risk of peri- and post-procedural complications is much higher than TAVR on native valve. In this review, we analyze the main procedural issues reported in the literature during ViV TAVR procedures: elevated postprocedural gradients, coronary obstruction and thrombosis of the leaflets of the bioprosthesis. Because of the opening of TAVR to younger and younger patients, thus with a longer life expectancy than the durability of the bioprosthesis, the next challenge will be the management of the lifetime strategy of patients with aortic stenosis, as the first type of intervention will influence all future therapeutic choices of our patient.

Keywords

Transcatheter aortic valve replacement / valve-in-valve / structural valve deterioration / bioprosthetic valve failure

References

[1] Vemulapalli S,Mack MJ.Procedural volume and outcomes for transcatheter aortic-valve replacement.N Engl J Med2019;380:2541-50

[2] Dvir D,Bleiziffer S.Valve-in-Valve International Data Registry InvestigatorsTranscatheter aortic valve implantation in failed bioprosthetic surgical valves.JAMA2014;312:162-70

[3] Carroll JD,Vemulapalli S.STS-ACC TVT registry of transcatheter aortic valve replacement.J Am Coll Cardiol2020;76:2492-516

[4] Webb JG,Alu MC.3-year outcomes after valve-in-valve transcatheter aortic valve replacement for degenerated bioprostheses: the PARTNER 2 registry.J Am Coll Cardiol2019;73:2647-55

[5] Capodanno D,Prendergast B.Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).Eur J Cardiothorac Surg2017;38:3382-90

[6] Généreux P,Alu MC.VARC-3 Writing CommitteeValve academic research consortium 3: updated endpoint definitions for aortic valve clinical research.J Am Coll Cardiol2021;77:2717-46

[7] Otto CM,Bonow RO.Writing Committee Members2020 ACC/AHA Guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.J Am Coll Cardiol2021;77:450-500

[8] Vahanian A,Praz F.2021 ESC/EACTS Guidelines for the management of valvular heart disease.EuroIntervention2022;17:e1126-96

[9] Sá MPBO,Simonato M.Valve-in-valve transcatheter aortic valve replacement versus redo surgical aortic valve replacement: an updated meta-analysis.JACC Cardiovasc Interv2021;14:211-20

[10] Thandra A,Jhand A.Valve-in-valve transcatheter aortic valve replacement versus redo surgical valve replacement for degenerated bioprosthetic aortic valve: an updated meta-analysis comparing midterm outcomes.Catheter Cardiovasc Interv2021;97:1481-8

[11] Saleem S,Syed MA.Meta-analysis comparing valve-in-valve TAVR and redo-SAVR in patients with degenerated bioprosthetic aortic valve.Catheter Cardiovasc Interv2021;98:940-7

[12] Tarantini G,Tang GHL.Transcatheter aortic valve implantation in degenerated surgical aortic valves.EuroIntervention2021;17:709-19

[13] Edelman JJ,Rogers T.Valve-in-valve TAVR: state-of-the-art review.Innovations (Phila)2019;14:299-310

[14] Simonato M.Transcatheter aortic valve replacement in failed surgical valves.Heart2019;105:s38-43

[15] Duncan A,Simonato M.Outcomes following transcatheter aortic valve replacement for degenerative stentless versus stented bioprostheses.JACC Cardiovasc Interv2019;12:1256-63

[16] Ribeiro HB,Blanke P.Incidence, predictors, and clinical outcomes of coronary obstruction following transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: insights from the VIVID registry.Eur Heart J2018;39:687-95

[17] Alnasser S,Simonato M.Valve-in-Valve International Data Registry InvestigatorsMatched comparison of self-expanding transcatheter heart valves for the treatment of failed aortic surgical bioprosthesis: insights from the valve-in-valve international data registry (VIVID).Circ Cardiovasc Interv2017;10:e004392

[18] Seiffert M,Schofer J.Matched comparison of next- and early-generation balloon-expandable transcatheter heart valve implantations in failed surgical aortic bioprostheses.EuroIntervention2018;14:e397-404

[19] Francone M,Bremerich J.CT and MR imaging prior to transcatheter aortic valve implantation: standardisation of scanning protocols, measurements and reporting-a consensus document by the European Society of Cardiovascular Radiology (ESCR).Eur Radiol2020;30:2627-50 PMCID:PMC7160220

[20] Bapat V.Valve-in-valve apps: why and how they were developed and how to use them.EuroIntervention2014;10 Suppl U:U44-51

[21] Jabbour RJ,Finkelstein A.Delayed coronary obstruction after transcatheter aortic valve replacement.J Am Coll Cardiol2018;71:1513-24

[22] Dvir D.Treatment of small surgical valves: clinical considerations for achieving optimal results in valve-in-valve procedures.JACC Cardiovasc Interv2015;8:2034-6

[23] Rodés-Cabau J,Suri RM.Impact of aortic annulus size on valve hemodynamics and clinical outcomes after transcatheter and surgical aortic valve replacement: insights from the PARTNER Trial.Circ Cardiovasc Interv2014;7:701-11

[24] Ochiai T,Sekhon N.Risk of coronary obstruction due to sinus sequestration in redo transcatheter aortic valve replacement.JACC Cardiovasc Interv2020;13:2617-27

[25] Blanke P,Dvir D.Computed tomography assessment for transcatheter aortic valve in valve implantation: the vancouver approach to predict anatomical risk for coronary obstruction and other considerations.J Cardiovasc Comput Tomogr2016;10:491-9

[26] Dvir D,Blanke P.Coronary obstruction in transcatheter aortic valve-in-valve implantation: preprocedural evaluation, device selection, protection, and treatment.Circ Cardiovasc Interv2015;8:e002079

[27] Mercanti F,Neylon A.Chimney stenting for coronary occlusion during TAVR: insights from the chimney registry.JACC Cardiovasc Interv2020;13:751-61

[28] Romano V,Latib A,Montorfano M.Chimney technique for coronary obstruction after aortic valve in valve: pros and cons.Eur Heart J Cardiovasc Imaging2018;19:1194

[29] Khan JM,Greenbaum AB.Transcatheter laceration of aortic leaflets to prevent coronary obstruction during transcatheter aortic valve replacement: concept to first-in-human.JACC Cardiovasc Interv2018;11:677-89 PMCID:PMC6309616

[30] Khan JM,Babaliaros VC.The BASILICA trial: prospective multicenter investigation of intentional leaflet laceration to prevent TAVR coronary obstruction.JACC Cardiovasc Interv2019;12:1240-52 PMCID:PMC6669893

[31] De Backer O, Søndergaard L. Is BASILICA the standard for preventing coronary obstruction in high-risk transcatheter aortic valve replacement?.JACC Cardiovasc Interv2021;14:949-51

[32] Khan JM,Greenbaum AB.Preventing coronary obstruction during transcatheter aortic valve replacement: results from the multicenter international BASILICA registry.JACC Cardiovasc Interv2021;14:941-8 PMCID:PMC8142224

[33] Tarantini G,Nai Fovino L.TAVR-in-TAVR and coronary access: importance of preprocedural planning.EuroIntervention2020;16:e129-32

[34] Nai Fovino L,Massussi M.Coronary angiography after transcatheter aortic valve replacement (TAVR) to evaluate the risk of coronary access impairment after TAVR-in-TAVR.J Am Heart Assoc2020;9:e016446 PMCID:PMC7670517

[35] Tang GHL,Gupta E.Feasibility of repeat tavr after SAPIEN 3 TAVR: a novel classification scheme and pilot angiographic study.JACC Cardiovasc Interv2019;12:1290-2

[36] Akodad M,Gulsin GS.Leaflet and neoskirt height in transcatheter heart valves: implications for repeat procedures and coronary access.JACC Cardiovasc Interv2021;14:2298-300

[37] Tang GHL,Tzemach L.Risk of coronary obstruction and the need to perform BASILICA: the VIVID classification.EuroIntervention2020;16:e757-9

[38] Tarantini G,Cardaioli F.Coronary access after transcatheter aortic valve replacement in patients with bicuspid aortic valve: lights and shades.JACC Cardiovasc Interv2019;12:1190-1

[39] De Backer O,Fuchs A.Coronary access after TAVR-in-TAVR as evaluated by multidetector computed tomography.JACC Cardiovasc Interv2020;13:2528-38

[40] Bilkhu R,Otto CM.Patient-prosthesis mismatch following aortic valve replacement.Heart2019;105:s28-33

[41] Wendt D,Plicht B.The new St Jude Trifecta versus Carpentier-Edwards Perimount Magna and Magna Ease aortic bioprosthesis: is there a hemodynamic superiority?.J Thorac Cardiovasc Surg2014;147:1553-60

[42] Herrmann HC,Fonarow GC.Prosthesis-patient mismatch in patients undergoing transcatheter aortic valve replacement: from the STS/ACC TVT registry.J Am Coll Cardiol2018;72:2701-11

[43] Vemulapalli S,Dai D.Valve hemodynamic deterioration and cardiovascular outcomes in TAVR: a report from the STS/ACC TVT Registry.Am Heart J2018;195:1-13

[44] Flameng W,Vercalsteren M,Bogaerts K.Prosthesis-patient mismatch predicts structural valve degeneration in bioprosthetic heart valves.Circulation2010;121:2123-9

[45] Jie Yao R, Simonato M, Dvir D; Department of Cardiology, St Paul’s Hospital, Vancouver, Canada, Department of Cardiology, St Paul’s Hospital, Vancouver, Canada, Department of Cardiology, St Paul’s Hospital, Vancouver, Canada. Optimising the haemodynamics of aortic valve-in-valve procedures.Interv Cardiol2017;12:40

[46] Pibarot P,Barbanti M.Impact of pre-existing prosthesis-patient mismatch on survival following aortic valve-in-valve procedures.JACC Cardiovasc Interv2018;11:133-41

[47] Jilaihawi H,Spyt T.Prosthesis-patient mismatch after transcatheter aortic valve implantation with the Medtronic-Corevalve bioprosthesis.Eur Heart J2010;31:857-64

[48] Simonato M,Bleiziffer S.Current generation balloon-expandable transcatheter valve positioning strategies during aortic valve-in-valve procedures and clinical outcomes.JACC Cardiovasc Interv2019;12:1606-17

[49] Simonato M,Webb J.In vitro evaluation of implantation depth in valve-in-valve using different transcatheter heart valves.EuroIntervention2016;12:909-17

[50] Azadani AN,Simonato M.Effect of transcatheter aortic valve size and position on valve-in-valve hemodynamics: an in vitro study.J Thorac Cardiovasc Surg2017;153:1303-15.e1

[51] Zenses AS,Stanová V.Effect of size and position of self-expanding transcatheter valve on haemodynamics following valve-in-valve procedure in small surgical bioprostheses: an in vitro study.EuroIntervention2018;14:e282-9

[52] Dvir D,Kornowski R.Novel strategies in aortic valve-in-valve therapy including bioprosthetic valve fracture and BASILICA.EuroIntervention2018;14:AB74-82

[53] Grubitzsch H,Falk V.Wrinkles, folds and calcifications: reduced durability after transcatheter aortic valve-in-valve replacement.J Thorac Cardiovasc Surg2017;153:266-8

[54] Allen KB,Cohen DJ.Bioprosthetic valve fracture to facilitate transcatheter valve-in-valve implantation.Ann Thorac Surg2017;104:1501-8

[55] Saxon JT,Cohen DJ.Bioprosthetic valve fracture during valve-in-valve TAVR: bench to bedside.Interv Cardiol2018;13:20-6 PMCID:PMC5872348

[56] Chhatriwalla AK,Saxon JT.Bioprosthetic valve fracture improves the hemodynamic results of valve-in-valve transcatheter aortic valve replacement.Circ Cardiovasc Interv2017;10:e005216

[57] Ziccardi MR.Bioprosthetic valve fracture for valve-in-valve transcatheter aortic valve replacement: rationale, patient selection, technique, and outcomes.Interv Cardiol Clin2019;8:373-82

[58] Nielsen-Kudsk JE,Therkelsen CJ.High-pressure balloon fracturing of small dysfunctional Mitroflow bioprostheses facilitates transcatheter aortic valve-in-valve implantation.EuroIntervention2017;13:e1020-5

[59] Patel JS,White J.Optimizing hemodynamics of transcatheter aortic valve-in-valve implantation in 19-mm surgical aortic prostheses.Catheter Cardiovasc Interv2018;92:550-4

[60] Tamagnini G,Rega F.Device profile of the Inspiris Resilia valve for aortic valve replacement: overview of its safety and efficacy.Expert Rev Med Devices2021;18:239-44

[61] Okamoto Y,Sugimoto T.Early and late outcomes of AVR with aortic annular enlargement in octogenarian.Gen Thorac Cardiovasc Surg2015;63:453-8

[62] Mack MJ,Thourani VH.PARTNER 3 InvestigatorsTranscatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients.N Engl J Med2019;380:1695-705

[63] Popma JJ,Yakubov SJ.Evolut Low Risk Trial InvestigatorsTranscatheter aortic-valve replacement with a self-expanding valve in low-risk patients.N Engl J Med2019;380:1706-15

[64] Tarantini G.Lifetime strategy of patients with aortic stenosis: the first cut is the deepest.JACC Cardiovasc Interv2021;14:1727-30

[65] Tarantini G,Le Prince P.Coronary access and percutaneous coronary intervention up to 3 years after transcatheter aortic valve implantation with a balloon-expandable valve.Circ Cardiovasc Interv2020;13:e008972 PMCID:PMC7373469

[66] Bapat VN,Fukuhara S.EXPLANT-TAVR InvestigatorsSurgical explantation after TAVR failure: Mid-term outcomes from the EXPLANT-TAVR international registry.JACC Cardiovasc Interv2021;14:1978-91

[67] Fukuhara S,Shiomi S.Surgical explantation of transcatheter aortic bioprostheses: results and clinical implications.J Thorac Cardiovasc Surg2021;162:539-47.e1 PMCID:PMC7388726

[68] Percy ED,Hirji S.Nationally representative repeat transcatheter aortic valve replacement outcomes: report from the centers for medicare and medicaid services.JACC Cardiovasc Interv2021;14:1717-26

[69] Hirji SA,McGurk S.Incidence, characteristics, predictors, and outcomes of surgical explantation after transcatheter aortic valve replacement.J Am Coll Cardiol2020;76:1848-59

[70] Landes U,De Backer O.Repeat transcatheter aortic valve replacement for transcatheter prosthesis dysfunction.J Am Coll Cardiol2020;75:1882-93

[71] Attizzani GF,Latib A.Acute and long-term (2-years) clinical outcomes of the CoreValve 31mm in large aortic annuli: a multicenter study.Int J Cardiol2017;227:543-9

[72] Barbanti M,Tamburino C.Outcomes of redo transcatheter aortic valve replacement for the treatment of postprocedural and late occurrence of paravalvular regurgitation and transcatheter valve failure.Circ Cardiovasc Interv2016;9:e003930

[73] Barbanti M,Picci A.Coronary cannulation after transcatheter aortic valve replacement: the RE-ACCESS study.JACC Cardiovasc Interv2020;13:2542-55

[74] Bleiziffer S,Webb JG.Long-term outcomes after transcatheter aortic valve implantation in failed bioprosthetic valves.Eur Heart J2020;41:2731-42

[75] Chakravarty T,Friedman J.Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study.Lancet2017;389:2383-92

[76] Blanke P,Popma JJ.Evolut Low Risk LTI Substudy InvestigatorsBioprosthetic aortic valve leaflet thickening in the evolut low risk sub-study.J Am Coll Cardiol2020;75:2430-42

[77] De Backer O, Dangas GD, Jilaihawi H, et al; GALILEO-4D Investigators. Reduced leaflet motion after transcatheter aortic-valve replacement.N Engl J Med2020;382:130-9

[78] Makkar RR,Jilaihawi H.Possible subclinical leaflet thrombosis in bioprosthetic aortic valves.N Engl J Med2015;373:2015-24

[79] Dangas GD,Wöhrle J.GALILEO InvestigatorsA controlled trial of rivaroxaban after transcatheter aortic-valve replacement.N Engl J Med2020;382:120-9

[80] Nijenhuis VJ,Delewi R.Anticoagulation with or without Clopidogrel after transcatheter aortic-valve implantation.N Engl J Med2020;382:1696-707

[81] Brouwer J,Delewi R.Aspirin with or without Clopidogrel after transcatheter aortic-valve implantation.N Engl J Med2020;383:1447-57

[82] Makkar RR,Leipsic J.Subclinical leaflet thrombosis in transcatheter and surgical bioprosthetic valves: PARTNER 3 cardiac computed tomography substudy.J Am Coll Cardiol2020;75:3003-15

[83] Abdel-Wahab M,Latib A.Clinical valve thrombosis after transcatheter aortic valve-in-valve implantation.Circ Cardiovasc Interv2018;11:e006730

[84] Ten Berg J,Rocca B.Management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation: a consensus document of the ESC Working Group on Thrombosis and the European Association of Percutaneous Cardiovascular Interventions (EAPCI), in collaboration with the ESC Council on Valvular Heart Disease.Eur Heart J2021;42:2265-9

[85] Jose J,El-Mawardy M.Clinical bioprosthetic heart valve thrombosis after transcatheter aortic valve replacement: incidence, characteristics, and treatment outcomes.JACC Cardiovasc Interv2017;10:686-97

[86] Vahidkhah K,Abbasi M.Blood stasis on transcatheter valve leaflets and implications for valve-in-valve leaflet thrombosis.Ann Thorac Surg2017;104:751-9

[87] Brown ML,Sundt TM.Early thrombosis risk in patients with biologic valves in the aortic position.J Thorac Cardiovasc Surg2012;144:108-11

[88] Eggebrecht H,Voigtländer T,Erbel R.Risk of stroke after transcatheter aortic valve implantation (TAVI): a meta-analysis of 10,037 published patients.EuroIntervention2012;8:129-38

[89] Eitan A,Haselbach T,Schofer J.Does valve in valve TAVR carry a higher risk for thromboembolic events compared to native valve TAVR?.Catheter Cardiovasc Interv2020;95:1017-21

[90] Macherey S,Mauri V.Meta-analysis of stroke and mortality rates in patients undergoing valve-in-valve transcatheter aortic valve replacement.J Am Heart Assoc2021;10:e019512 PMCID:PMC8174195

[91] Lansky AJ,Tchetche D.A prospective randomized evaluation of the TriGuard™ HDH embolic DEFLECTion device during transcatheter aortic valve implantation: results from the DEFLECT III trial.Eur Heart J2015;36:2070-8

[92] Kapadia SR,Makkar R.SENTINEL Trial InvestigatorsProtection against cerebral embolism during transcatheter aortic valve replacement.J Am Coll Cardiol2017;69:367-77

[93] Shimamura J,Malik A.Safety and efficacy of cerebral embolic protection devices in patients undergoing transcatheter aortic valve replacement: a meta-analysis of in-hospital outcomes.Cardiovasc Interv Ther2021;