1. How to treat severe symptomatic structural valve deterioration of aortic surgical bioprosthesis: transcatheter valve-in-valve implantation or redo valve surgery?
- Author
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Mohammed Nejjari, Francesco Nappi, Mackram F. Eleid, Julien Dreyfus, David Attias, and Charanjit S. Rihal
- Subjects
Reoperation ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Valve surgery ,030204 cardiovascular system & hematology ,Prosthesis Design ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Older patients ,Risk Factors ,medicine.artery ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Risks and benefits ,Aged ,Aged, 80 and over ,Bioprosthesis ,Aorta ,business.industry ,General Medicine ,Middle Aged ,Optimal management ,Valve in valve ,Prosthesis Failure ,Surgery ,Treatment Outcome ,Aortic Valve ,Heart Valve Prosthesis ,Redo surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
The optimal management of aortic surgical bioprosthesis presenting with severe symptomatic structural valve deterioration is currently a matter of debate. Over the past 20 years, the number of implanted bioprostheses worldwide has been rapidly increasing at the expense of mechanical prostheses. A large proportion of patients, however, will require intervention for bioprosthesis structural valve deterioration. Current options for older patients who often have severe comorbidities include either transcatheter valve-in-valve (TVIV) implantation or redo valve surgery. The emergence of TVIV implantation, which is perceived to be less invasive than redo valve surgery, offers an effective alternative to surgery for these patients with proven safety and efficacy in high-risk patient groups including elderly and frail patients. A potential caveat to this strategy is that results of long-term follow-up after TVIV implantation are limited. Redo surgery is sometimes preferable, especially for young patients with a smaller-sized aortic bioprosthesis. With the emergence of TVIV implantation and the long experience of redo valve surgery, we currently have 2 complementary treatment modalities, allowing a tailor-made and patient-orientated intervention. In the heart team, the decision-making should be based on several factors including type of bioprosthesis failure, age, comorbidities, operative risk, anatomical factors, anticipated risks and benefits of each alternative, patient's choice and local experience. The aim of this review is to provide a framework for individualized optimal treatment strategies in patients with failed aortic surgical bioprosthesis.
- Published
- 2018