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The Progression of Transcatheter Valve replacement: An Option in Deteriorating Bioprosthetic Valves
elizabeth K. walsh, Elizabeth Cichonski, Nimesh Desai, MD, Saif Anwarrudin, MD, wilson Szeto, MD, Robert Li, MD, Prashanth Vallabhajosyula, MD, Jay Giri, Matthew Williams, MD, Howard Herrmann, MD, Joseph Bavaria, MD.
The University of Pennsylvania Hospital, Philadelphia, PA, USA.

OBJECTIVE: The evolution of Transcatheter Valve Replacement (TVR) has expanded into a treatment option for patients with failing prosthetic (FPHV) heart valves. Heart Teams are considering this choice for high risk patients. The purpose of this discussion is to examine the outcomes of patients with failing prosthetic valves who are treated with TVR.
METHODS: A retrospective review of a single institutionís cohort of patients who were treated with TVR for their failing bioprosthetic valve. The treated valves included aortic, mitral and tricuspid valves. The valves used were balloon expandable and self-expandable. The demographics included age, gender and Society of Thoracic Surgery Risk calculation (STS) and technically inoperable patients. The data presented includes access injury, stroke and mortality through 30 days.
RESULTS: 43 patients with the average STS of 7.68%(+/- 0.06%) were treated with TVR for their failing prosthetic heart valve from 2012 through 2018. The mean age was 74.58(+/-8.42), 26 males and 17 females. 39 aortic valves, 4 mitral valves (1 patient aortic, mitral) and 1 tricuspid valves were treated. 5 were technically inoperable and 38 were deemed high risk due to comorbidities. 12 were treated with self-expandable and 31 were treated with balloon expandable. 23 were transfemoral, 5 transapical and 2 transeptal approaches. 30-day outcomes include 5 sustained access injuries, 0 strokes and 2(5%) deaths.
CONCLUSIONS: TVR is a game changer for the treatment of aortic stenosis. Tissue valves are often the patientís valve of choice when their native valve is dysfunctional, however over time tissue valves will fail. The use of TVR in FPHV has proven to be feasible. Long-term durability is unknown. However, TVR has been a viable option and perhaps the only option for patients who are high risk or inoperable.


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