Complications of Bioprosthetic Valve Fracture as an Adjunct to Valve-in-Valve TAVR

ABSTRACTValve-in-valve transcatheter aortic valve replacement (VIV TAVR) is a safe and effective method of treating patients with failed bioprosthetic surgical valves (BSVs) at high risk of reoperation. However, one of the major limitations of VIV TAVR is patient–prosthesis mismatch (PPM), particularly in small BSVs. PPM is associated with increased mortality following VIV TAVR. Bioprosthetic valve fracture (BVF) as an adjunct to VIV TAVR has been shown to be a safe and effective method in terms of improving postprocedural hemodynamics and eliminating PPM after VIV TAVR in several case series. As BVF has become more widely used, complications specific to the procedure have become more apparent. This review focuses on the knowledge gained from several cases of BVF for VIV TAVR, and how these specific examples lend insight into best practices when performing this procedure.