Status and prospect of transcatheter valve-in-valve implantation for biological valve degeneration
Along with the coming of aged society,the prevalence of heart valvular disease is significantly increasing,and the use of bioprosthetic valves for treating patients with severe valve disease has increased over the last two decades.As a consequence,a growing number of patients with surgical bioprosthesis degeneration is predicted in the near future.In this setting,valve-in-valve(ViV)transcatheter aortic/mitral valve replacement(TAVR/TMVR)has emerged as an alternative to redo surgery.A deep knowledge of the mechanism and features of the failed bioprosthetic heart valve is pivotal to plan an adequate procedure.Multimodal imaging is fundamental in the diagnostic and pre-procedural phases.The immediate and mid-term clinical and hemodynamic results have demonstrated the safety and feasibility of ViV techniques,but the development of these techniques faces several specific challenges,such as coronary obstruction,potential post-procedural mismatch and leaflet thrombosis.This article reviews the current status and prospects of ViV-TAVR technology in the treatment for biological valve degeneration,and suggests that ViV-TAVR should be promoted and implemented in existing medical centers with good surgical aortic valve replacement experience,so as to provide better treatment for patients.
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