Page 72 - Read Online

Annibali et al. Mini-invasive Surg 2022;6:12 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.101

Review Open Access

Valve-in-valve transcatheter aortic valve

replacement: the challenge of the next future

Gianmarco Annibali, Innocenzo Scrocca, Giuseppe Musumeci
Cardiology Division, Azienda Ospedaliera Ordine Mauriziano Umberto I, Turin 10128, Italy.

Correspondence to: Dr. Giuseppe Musumeci, Cardiology Division, Azienda Ospedaliera Ordine Mauriziano Umberto I, Largo
Filippo Turati, 62, Turin 10128, Italy. E-mail: giuseppe.musumeci@gmail.com

How to cite this article: Annibali G, Scrocca I, Musumeci G. Valve-in-valve transcatheter aortic valve replacement: the challenge
of the next future. Mini-invasive Surg 2022;6:12. https://dx.doi.org/10.20517/2574-1225.2021.101

Received: 27 Aug 2021 First Decision: 13 Dec 2021 Revised: 14 Jan 2022 Accepted: 27 Jan 2022 Published: 24 Feb 2022

Academic Editor: Andrea Scotti Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

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

INTRODUCTION
In the last decade, transcatheter aortic valve replacement (TAVR) has dramatically changed the

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.misjournal.net