Valve in Valve

The first mechanical heart valve prosthesis, designed by Dr Charles Hufnagel, was implanted to the descending aorta of a 30-year-old woman with severe aortic regurgitation in 1952.1 Eight years after the initial successful prosthetic valve implantation, Dr Harken sutured a prosthetic valve (Starr Edwards Valve) to the aortic annulus after removing the diseased native valve. During the ensuing years, different types of valves made from pyrolytic carbon were tried. Though they successfully remedied the aortic valve disease, mechanical prosthesis required lifelong anticoagulation, resulting in high rates of bleeding and thrombosis complications.Article see p 2335In the 1960s, valves with leaflets that were made from animal tissue were developed as an alternative without an anticoagulation requirement. Indeed, they were superior to mechanical prosthesis in that regard, but they did not last nearly as long. In randomized trials of bioprosthetic or mechanical valves, which started enrollment in 1970s, primary valve failure and reoperation rates were higher in patients receiving bioprosthetic valves, especially in patients aged <65 years.2–4 Since these initial reports, several important advancements have been made in design and tissue processing to improve valve hemodynamics and durability. With these improvements, the age cutoff to use bioprosthetic valves was gradually lowered to avoid lifelong anticoagulation. Large studies with prospectively collected data and long-term follow-up are not yet available to determine the clinical impact of such a trend.5Until recently, reoperation was the only choice for symptomatic patients with degenerated aortic bioprosthesis. Advanced age and multiple comorbidities put some patients at a higher risk for a repeat open heart surgery, and for many this risk is so prohibitive that there is no other treatment option.6–9 Advancements in transcatheter aortic valve replacement (TAVR), and the first successful reported case of VIV (valve in valve) in …