Faculty Opinions recommendation of Structural Deterioration of Transcatheter Versus Surgical Aortic Valve Bioprostheses in the PARTNER-2 Trial.

Abstract Background Aortic valve neocuspidization (AVNeo), a novel surgical procedure used in the treatment of aortic valve diseases, including aortic stenosis (AS), involves the replacement of three aortic valve cusps by glutaraldehyde-treated autologous pericardium. Although reoperation risk is low, no case report on the deterioration of the AVNeo has yet been published. Case summary An 80-year-old woman who underwent AVNeo for severe degenerative tricuspid AS 6 years previously complained of shortness of breath. Echocardiographic assessment revealed the reconstructed aortic valve leaflet was elongated, thickened, and marginally calcified resulting in recurrent severe AS. Transcatheter aortic valve implantation using balloon-expandable transcatheter heart valve was successfully performed. Discussion To our knowledge, this is the first case report regarding the structural deterioration of the AVNeo resulting in restenosis 6 years after the first surgery. Transcatheter aortic valve implantation is possibly a suitable approach for post-procedural recurrence after AVNeo to avoid redo open-heart surgery which would be of prohibitive risk especially in an elderly population.

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Assessment of long-term structural deterioration of transcatheter aortic bioprosthetic valves

European Heart Journal ◽

10.1093/ehjci/ehaa946.2589 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

E Durand ◽

T Hemery ◽

T Levesque ◽

C Tron ◽

P.Y Litzler ◽

...

Keyword(s):

Aortic Valve ◽

Lower Risk ◽

Aortic Valve Area ◽

Transcatheter Aortic Valve ◽

Structural Deterioration ◽

Post Procedure ◽

Risk Patients ◽

Bioprosthetic Valves

Abstract Background The durability of transcatheter aortic bioprosthetic valves is a crucial issue in the context of extension of indications in younger and lower-risk patients, but data are scarce, especially beyond 5 years of follow-up. This study sought to evaluate the incidence of structural valve degeneration (SVD) 5 to 10 years post-procedure. Methods Demographic, procedural, and in-hospital outcome data on patients who underwent transcatheter aortic valve implantation (TAVI) from 2002 to 2014 were obtained from our prospective institutional database. Patients in whom echocardiographic data were available both at baseline and 5 years post-TAVI were included. Clinical and echocardiographic follow-up were performed on site annually. Hemodynamic SVD was determined according to European task force committee guidelines. Results A total of 208 patients (82.5±7.6 years of age; 53% female) with paired post-procedure and late echocardiographic follow-up (median 5.3 years, range 5 to 11.4 years) were included. Eleven (5.3%) patients were treated with a self-expandable valve and 197 (94.7%) patients with a balloon-expandable valve. Mean aortic valve gradient and effective aortic valve area remained unchanged during follow-up. There were 2 cases (1.0%) of severe SVD 6 and 7 years after implantation requiring redo-TAVI. There were 4 cases (1.9%) of moderate SVD (mean 6.0 years post-implantation; range 5 to 7 years). Conclusions Our data do not demonstrate any alarm on transcatheter aortic valve durability. Careful prospective assessment in younger and lower risk patients and comparison with surgical bioprosthetic valves are required to further assess long-term durability of transcatheter valves. Funding Acknowledgement Type of funding source: None

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Surgical explantation of a failed transcatheter aortic valve

10.1510/mmcts.2021.056 ◽

2021 ◽

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Lower Risk ◽

Transcatheter Aortic Valve Replacement ◽

Surgical Aortic Valve Replacement ◽

Native Valve ◽

Transcatheter Aortic Valve ◽

Structural Deterioration ◽

Structural Valve Deterioration

With transcatheter aortic valve replacement being increasingly utilized in a younger and lower risk population, we can expect to see larger numbers of patients presenting with structural deterioration of aortic valves replaced by the transcatheter route that now require explantation and surgical replacement. Surgical aortic valve replacement after transcatheter aortic valve replacement is associated with operative morbidity and mortality rates significantly higher than those seen in the setting of surgical replacement of the native valve, which had a 30-day mortality of 12–20% in recent series. Centers performing transcatheter aortic valve replacement in lower risk patients with longer expected lifespans and a higher probability of late structural deterioration of the transcatheter aortic valve replacement should carefully consider their choice of valve type (balloon-expandable versus self-expanding) and patient anatomy, including annulus and root diameter, at the time of the initial valve intervention. Further, one should not forget the mechanical surgical aortic valve replacement option in younger patients with risk factors for early structural valve deterioration such as obesity, metabolic syndrome, and chronic kidney disease. The objectives of this tutorial are to describe the preoperative workup for a patient with late structural valve deterioration after transcatheter aortic valve replacement, detail the explantation approach specific to self-expanding valves, and illustrate the key decisions and techniques needed for subsequent surgical aortic valve replacement.

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Carpentier-Edwards Bioprosthesis: Structural Deterioration by Age Groups

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239700500402 ◽

1997 ◽

Vol 5 (4) ◽

pp. 193-198 ◽

Cited By ~ 3

Author(s):

WR Eric Jamieson ◽

Hilton Ling ◽

Lawrence H Burr ◽

Guy J Fradet ◽

Robert T Miyagishima ◽

...

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Valve Replacement ◽

Age Groups ◽

Structural Deterioration ◽

Mitral Position ◽

Structural Valve Deterioration ◽

Porcine Bioprosthesis ◽

Valve Position ◽

The Mean

The Carpentier-Edwards supra-annular porcine bioprosthesis (second generation prosthesis) was implanted in 2438 patients in 2482 operations between 1982 and 1992. The mean age of the population was 64 years with a range from 21 years to 89 years. There were 1334 aortic and 934 mitral valve replacements. The population was divided into five groups: 21 to 40 years (n = 132); 41 to 50 years (n = 189); 51 to 60 years (n = 454); 61 to 70 years (n = 849); and over 70 years (n = 858). There was no difference in sunival by valve position for age groups 21 to 40 years and 41 to 50 years. Sunival within the age groups 51 to 60 years, 61 to 70 years, and over 70 years was greater for patients with aortic compared with mitral and multiple valve replacements. The freedom from structural valve deterioration at 10 years for all age groups was highest for valves in the aortic position. Patients with valves in the mitral position had a higher freedom from structural valve deterioration at 10 years than those who had multiple valve replacement, although not all the differences were significant. There was a lower incidence of structural valve deterioration in the older age groups. We concluded that the use of the Carpentier-Edwards supra-annular porcine bioprosthesis for aortic valve replacement can be extended to patients over 60 years of age, while its use for mitral valve replacement can be extended to those above 70 years of age.

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TAVI Beyond 3 Years: Durability and Predictors for Survival

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/15569845211017558 ◽

2021 ◽

pp. 155698452110175

Author(s):

Faisal Rahman ◽

Jon R. Resar

Keyword(s):

Aortic Valve ◽

Valve Replacement ◽

Fibrous Tissue ◽

Current Status ◽

Paravalvular Leak ◽

Surgical Aortic Valve Replacement ◽

Term Survival ◽

Structural Deterioration ◽

Surgical Valve Replacement

The use of transcatheter aortic valve implantation (TAVI) has greatly increased over the past 2 decades and now has overtaken surgical aortic valve replacement. We have limited data regarding the long-term durability of TAVI and the predictors of survival. Calcification, inflammation, fibrous tissue deposition, and mechanical stress are important in the structural deterioration of surgical bioprosthetic valves and likely contribute to TAVI durability. However, TAVI has several differences to surgical valve replacement such as valve preparation, valve to native anatomy interaction, and valve sizing which all likely contribute to durability and long-term survival. Most procedures have been performed on older patients and therefore long-term follow-up studies have noted mortality of approximately 50% at 5 years and 75% by 7 years. Current data are limited by the high mortality of patients who have received TAVI often as a result of age, frailty, and other competing comorbidities. TAVI as compared with surgical valve replacement is associated with several differences including higher conduction abnormalities (i.e., need for pacemakers) and paravalvular leak, both of which may affect long-term morbidity and mortality. In this review, we discuss the current status of our knowledge and identify areas that require further investigation.

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