Implantation of a valve within a valve for bioprosthetic valve failure

Implantation of a valve within a valve for bioprosthetic valve failure

Implantation of a valve within a valve for bioprosthetic valve failure: The report by John G Webb, David A Wood, Jian Ye, Ronen Gurvitch, Jean-Bernard Masson, Josep Rodés-Cabau, Mark Osten, Eric Horlick, O Wendler, Eric Dumont, Ronald G Carere, Namal Wijesinghe, Fabian Nietlispach, Mark Johnson, Chrisopher R Thompson, Robert Moss, Jonathon Leipsic, Brad Munt, Samuel V Lichtenstein and Anson Cheung in Circulation [1] gives a ray of hope for very sick patients with bioprosthetic valve failure. As the number of individuals with implanted bioprosthetic valves are increasing, so is the number of those with eventual degeneration and failure of these valves. There is a significant morbidity and mortality associated with surgery for replacement of these valves, especially in those who are having functional class III or IV. The current study evaluated trans catheter implantation of valve within the failed valve (valve-in-valve). Twenty four high risk patients underwent the procedures. Ten of them had failed aortic valves while seven had failed mitral valves. Failed pulmonary valves were there in six and tricuspid in one of them. Procedure was successful in all but one of them. None had more than mild valvular regurgitation after the implantation and there was no mortality during the procedure. Mortality rate at thirty days was 4.2%. While 88% were in NYHA (New York Heart Association) class III or IV at baseline, same percentage of them were in class I or II at last follow up. Median follow up period was 135 days and the maximum follow up was 1045 days. Survival rate with satisfactory valve function was 91.7%. Let us hope that this percutaneous management of failed bioprosthetic valves will gather momentum and become the standard of care in near future for not just the very sick patients not fit for surgical options, but also for others with bioprosthetic valve failure. Larger databases and study reports are needed to achieve this goal. Moreover, the steep learning curve has also to be tackled.

Reference

  1. John G Webb, David A Wood, Jian Ye, Ronen Gurvitch, Jean-Bernard Masson, Josep Rodés-Cabau, Mark Osten, Eric Horlick, O Wendler, Eric Dumont, Ronald G Carere, Namal Wijesinghe, Fabian Nietlispach, Mark Johnson, Chrisopher R Thompson, Robert Moss, Jonathon Leipsic, Brad Munt, Samuel V Lichtenstein, Anson Cheung. Transcatheter valve-in-valve implantation for failed bioprosthetic heart valves. Circulation. 2010 Apr 27;121(16):1848-57.