#Guideliner balloon anchor te full
The Lotus valve has a number of attractive features for bicuspid anatomy, specifically very low rates of PVL, minimal need for postdilatation, slow and controlled deployment, and full retrievability and repositionability. Finally, a self-expanding or mechanically expanded valve may be preferable to a balloon-expandable device, both to conform to an asymmetric valve orifice and to reduce risk of annular rupture. 14 The ability to retrieve and reposition is also favorable in view of the elevated risk of malpositioning. A device with minimal PVL is desirable, given its increased incidence and the association of moderate to severe PVL with increased mortality. When selecting a valve for TAVI within bicuspid anatomy, a number of specific attributes can be useful in mitigating these complications. Complications arising more frequently after TAVI in this cohort include significant PVL, nonuniform/noncircular valve deployment, device migration/embolization, and annular rupture. 5,6 These anatomic variations present a number of challenges to TAVI, and studies have highlighted poorer outcomes among this population. BICUSPID AORTIC VALVESīicuspid aortic valves are often associated with larger annulus dimensions, an asymmetric valve orifice, heavy calcification, and a dilated and asymmetric aortic root and ascending aorta.
#Guideliner balloon anchor te series
There are very few data beyond case series describing outcomes with the other available TAVI valves. 1 Although the use of bioprosthetic valve fracture with high-pressure noncompliant balloons has emerged as a treatment option for a high residual gradient after ViV TAVI, data on this strategy remain limited. As a result, the function of the CoreValve is less affected by the constraining surgical sewing ring, allowing for a larger potential orifice area.
2 This is likely to be explained by a fundamental design difference between the two valves the CoreValve (and its successor Evolut) is a supra-annular device, in contrast to the intra-annular Sapien valve. 1 Sapien use was an independent predictor of an elevated gradient, a finding corroborated in a recent meta-analysis. This difference was most marked in small (internal diameter < 20 mm) surgical bioprostheses (58.8% vs 20%, respectively P =. A mean gradient ≥ 20 mm Hg was seen more frequently after use of Sapien valves than with CoreValve (40% vs 21.3%, respectively P <.
In the VIVID registry, a high postprocedural gradient, defined as a mean gradient ≥ 20 mm Hg, was noted in 28.4% of cases and was an independent predictor of increased late mortality. However, there are no substantive data to back up this theoretical benefit. 1 In theory, a fully retrievable valve such as the Lotus device (Boston Scientific Corporation) may confer an advantage in allowing device retrieval in the event of coronary obstruction. In the VIVID registry, there was no difference between the CoreValve and Sapien valves in the incidence of coronary obstruction. 1 This risk is primarily determined by the geometry of the surgical valve and the anatomy of the sinuses rather than TAVI valve type. The incidence of coronary obstruction was noted to be 3.5% in the VIVID registry. By far the greatest experience and evidence in ViV TAVI is with the use of the CoreValve/Evolut (Medtronic) and Sapien (Edwards Lifesciences) valves.
The principal challenges of valve-in-valve (ViV) TAVI are the increased risk of coronary obstruction from the displaced bioprosthetic leaflets and the elevated postprocedural pressure gradients due to the interaction between the transcatheter and surgical valves. DEGENERATIVE SURGICAL BIOPROSTHESES: VALVE-IN-VALVE TAVI