Valve-in-Valve TAVI for Degenerated Surgical Prostheses

S ince the first transcatheter aortic valve implantation (TAVI) by Dr. Alain Cribier was reported in 2002, the field of TAVI has grown steadily and, at times, exponentially.1 Surgeons and cardiologists have continued to innovate and broaden the range of applications for TAVI. Initially developed for aortic stenosis, TAVI has been performed by either a transfemoral or transapical approach. Subsequently, the transarterial approach has been expanded to transaxillary approaches, as well as transaortic approaches.2 Although the access sites have been expanded, so have the indications. As the world’s population ages, more patients will be deemed high risk or unsuitable for the standard of care, which continues to be surgical replacement. In these patients, TAVI has become an attractive alternative. In the United States, the PARTNER (Placement of Aortic Transcatheter Valves) trial, which is evaluating the Edwards Sapien transcatheter heart valve (Edwards Lifesciences, Irvine, CA), has recently completed enrollment, and plans for a second phase of the trial are already underway. Outside of the United States, the Sapien valve and CoreValve (Medtronic, Inc., Minneapolis, MN) are commercially available for TAVI. Off-label use of the valve around the world continues to advance the growing field, and one of the frontiers of innovation is the use of TAVI in degenerated prostheses. Valve-in-Valve TAVI for Degenerated Surgical Prostheses