Valve-in-Valve for Transcatheter Aortic Valve Replacement: Do Imaging Requirements Change?
Bioprosthetic surgical valves have shorter durability compared to mechanical devices and the risk of reoperation is often prohibitively high. Contemporary transcatheter valves have been, and will continue to be, successfully deployed within failing surgical prostheses utilizing a valve-in-valve technique. Detailed knowledge of the physical characteristics of the in situ surgical prosthesis is crucial for procedural success. Currently, the internal diameter of the surgical valve is the most important dimension used to size transcatheter valves. Unfortunately, there is significant variability in both labeling and reported dimensions between surgical valve manufacturers with no accepted gold standard. Multiple novel transcatheter valve systems are currently being developed for valve-in-valve applications that utilize a variety of innovative sizing criteria. Imaging plays a key role in all aspects of valve-in-valve implantation. Multidetector computed tomography (MDCT) can help size existing surgical prosthesis and is proving invaluable for next-generation device development and refinement. Although echocardiography provides important periprocedural guidance for radiolucent surgical prostheses, a detailed understanding of the radiopaque surgical landmarks is crucial for correct valve-in-valve positioning and thus successful implantation.
KeywordsBioprosthetic valve Transcatheter valve Valve-in-valve Internal diameter Fluoroscopic markers
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