Valve-in-Valve for Transcatheter Aortic Valve Replacement: Do Imaging Requirements Change?



Fig. 32.1
Incidence of structural valve degeneration (SVD) with surgical bioprosthetic valves



A301676_1_En_32_Fig2_HTML.gif


Fig. 32.2
One-year outcome results from the Global Valve-in-Valve Registry (n = 78). AV aortic valve, NYHA New York Heart Association (Image courtesy of Dr Danny Dvir, Washington Hospital Center, Washington DC, USA)


It is recognized that the valve-in-valve procedure is technically challenging and requires appropriate case and device selection. Imaging plays a key role in all aspects of valve-in-valve implantation. Multidetector computed tomography (MDCT), echocardiography, and periprocedural angiography to evaluate the radiopaque surgical landmarks are all crucial for correct valve-in-valve sizing and positioning and thus, successful implantation. We will review imaging requirements for valve-in-valve implantation for failed surgical bioprostheses. Valve-in-valve implantation for failed or malpositioned transcatheter valves is a separate topic and not discussed.



Surgical Valves


Bioprosthetic surgical valves have consistent, reproducible leaflet kinetics as the leaflets are mounted in a rigid framework. The wide variety of surgical valves available can be broadly classified into stented and stentless devices (Tables 32.1 and 32.2). These groups have unique features that must be considered for valve-in-valve sizing and positioning. Conventional bioprosthetic valves incorporate bovine or porcine pericardium incorporated into a stent frame or stentless conduit.


Table 32.1
Structural dimensions of stented bioprosthetic valves




























































































































































































































































































































































Valve label size
Valve type/model (manufacturer)
Sewing ring external diameter, mm
Stent outer diameter, mm
Stent internal diameter, mm
Profile height, mm

18
Soprano (Sorin Biomedica)
26
21
17.8
12

19
Magna (Edwards Lifesciences)
24
19
18
13

Perimount (Edwards Lifesciences)
26
19
18
14

Mosaic (Medtronic)
25
19
17.5
13.5

Hancock Ultra (Medtronic)
24
19
17.5
14

Mitroflow (Sorin Biomedica)
21
18.6
15.4
11

Trifecta (St. Jude Medical)
24
19
17
15

Epic Supra/Biocor Supra (St. Jude Medical)
25
19
19
14

20
Soprano (Sorin Biomedica)
28
23
19.8
14

Aspire (Vascutek Terumo)
23
20
18.2
16

21
Magna (Edwards Lifesciences)
26
21
20
15

Perimount (Edwards Lifesciences)
29
21
20
15

Mosaic/Hancock II (Medtronic)
27
21
18.5
15

Hancock/Hancock Ultra (Medtronic)
26
21
18.5
  

Mitroflow (Sorin Biomedica)
23
20.7
17.3
13

Trifecta (St. Jude Medical)
26
21
19
16

Epic/Biocor (St. Jude Medical)
25
21
19
14

Aspire (Vascutek Terumo)
24
21
19.2
16

22
Soprano (Sorin Biomedica)
30
25
21.7
15

23
Magna (Edwards Lifesciences)
28
23
22
16

Perimount (Edwards Lifesciences)
31
23
22
16

Mosaic/Hancock II (Medtronic)
30
23
20.5
16

Hancock/Hancock Ultra (Medtronic)
28
23
22
  

Mitroflow (Sorin Biomedica)
26
22.7
19
14

Trifecta (St. Jude Medical)
28
23
21
17

Epic/Biocor (St. Jude Medical)
27
23
21
15

Aspire (Vascutek Terumo)
26
23
21
17

24
Soprano (Sorin Biomedica)
32
27
23.7
16

25
Magna (Edwards Lifesciences)
28
23
22
17

Perimount (Edwards Lifesciences)
31
23
22
17

Mosaic/Hancock II (Medtronic)
33
25
22.5
17.5

Mosaic Ultra/Hancock I Ultra (Medtronic)
30
25
22.5
  

Mitroflow (Sorin Biomedica)
29
25.1
21
15

Trifecta (St. Jude Medical)
31
25
23
18

Epic/Biocor (St. Jude Medical)
29
25
23
16

Epic Supra (St. Jude Medical)
N/A
25
25
  

Aspire (Vascutek Terumo)
28
25
23
18

26
Soprano (Sorin Biomedica)
35
29
25.6
19

27
Magna (Edwards Lifesciences)
32
27
26
18

Perimount (Edwards Lifesciences)
35
27
26
18

Mosaic/Hancock II (Medtronic)
36
27
24
18.5

Mosaic Ultra/Hancock II Ultra (Medtronic)
32
27
24
  

Mitroflow (Sorin Biomedica)
31
27.3
22.9
16

Trifecta (St. Jude Medical)
33
27
25
19

Epic/Biocor (St. Jude Medical)
31
27
25
17

Aspire (Vascutek Terumo)
30
27
25
18

28
Soprano (Sorin Biomedica)
38
31
27.6
19

29
Magna (Edwards Lifesciences)
34
29
28
19

Perimount (Edwards Lifesciences)
37
29
28
19

Mosaic/Hancock II (Medtronic)
39
29
26
20

Mosaic Ultra/Hancock II Ultra (Medtronic)
34
29
26
  

Mitroflow (Sorin Biomedica)
33
29.5
24.7
16

Trifecta (St. Jude Medical)
35
29
27
20



Table 32.2
Structural dimensions of stentless bioprosthetic valves







































































Valve label size
Bioprosthesis
Manufacturer
Outer diameter, mm
Internal diameter, mm

19
Freestyle
Medtronic
19
16

Prima Plus
Edwards Lifesciences
19
16

3 F Therapeutics
ATS Medical
19
17

Pericarbon Freedom
Sorin Biomedica
19
17

21
Freestyle
Medtronic
21
18

Prima Plus
Edwards Lifesciences
21
18

3 F Therapeutics
ATS Medical
21
19

Toronto SPV
St. Jude Medical
21
18

Pericarbon freedom
Sorin Biomedica
21
19

23
Freestyle
Medtronic
23
20

Prima Plus

Only gold members can continue reading. Log In or Register to continue

Related posts:

Transcatheter Aortic Valve Replacement: Current Evidence from Large Multicenter Registries Positron Emission Tomography Evaluation of Aortic Stenosis Pathologic Findings in Aortic Stenosis Transcatheter Aortic Valve Replacement in Patients with Chronic Kidney Disease: Pre-procedural Assessment and Procedural Techniques to Minimize Risk for Acute Kidney Injury Aortoiliofemoral Angiography and IVUS Structural and Hemodynamic Integrity of the Implanted TAVR Valve

Stay updated, free articles. Join our Telegram channel
Tags:
Aug 24, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Valve-in-Valve for Transcatheter Aortic Valve Replacement: Do Imaging Requirements Change?

Full access? Get Clinical Tree

 Get Clinical Tree app for offline access