Author + information
- Received December 14, 2017
- Revision received March 1, 2018
- Accepted March 8, 2018
- Published online January 7, 2019.
- Erwan Salaun, MDa,b,∗,
- Anne-Sophie Zenses, Eng.a,c,∗,
- Marie-Annick Clavel, DVM, PhDa,
- Tania Rodriguez-Gabella, MDa,
- Eric Dumont, MDa,
- Siamak Mohammadi, MDa,
- Daniel Doyle, MDa,
- Jean-Michel Paradis, MDa,
- Robert De Larochelliere, MDa,
- Philippe Pibarot, DVM, PhDa,∗ ( and )
- Josep Rodés-Cabau, MDa
- aInstitut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, Québec, Canada
- bCentre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR 7339, Centre National de la Recherche Scientifique, Aix-Marseille Université, Marseille, France
- cIFSTTAR, LBA UMR_T24, Aix-Marseille Université, Marseille, France
- ↵∗Address for correspondence:
Dr. Philippe Pibarot, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy #A2075, Québec, Québec G1V-4G5, Canada.
Transcatheter aortic valve replacement (TAVR) is being increasingly used for the treatment of severe native aortic valve stenosis. Initially performed in patients with prohibitive or high surgical risk, TAVR is now considered as a valid alternative in patients with intermediate risk and is being tested in patients with low surgical risk. However, little is known about the midterm and long-term durability of transcatheter aortic valves (TAV) and only a few cases of structural valve failure have been reported. Although transcatheter valve-in-valve (ViV) procedure is now recognized as a good alternative to redo surgery in high-risk patients with failed surgical bioprostheses, there are few data on ViV within failed TAVs. This article presents 5 illustrative cases of structural deterioration of TAVs occurring at a median time of 5 years (minimum: 3 years; maximum: 8 years) after the initial TAVR and treated by ViV (TAV-in-TAV) (Table 1, Figures 1, 2, 3, 4, and 5⇓⇓⇓⇓⇓).
To conclude: 1) Stenosis was the predominant mode of TAV failure in this series. 2) Noncontrast computed tomography is useful for detection of valve leaflet mineralization, which is an early surrogate marker of structural valve deterioration of transcatheter or surgical bioprostheses (1). This imaging modality should be implemented in the follow-up of the valve structural integrity following TAVR (2). And 3) TAV-in-TAV led to satisfactory hemodynamic results in all patients.
↵∗ Drs. Salaun and Zenses contributed equally to this work and are joint first authors.
Dr. Pibarot has received research grants from Edwards Lifesciences and Medtronic for echocardiography core laboratory analyses in transcatheter aortic valve replacement. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 14, 2017.
- Revision received March 1, 2018.
- Accepted March 8, 2018.
- 2019 American College of Cardiology Foundation
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