ValveinvalveTechniken

ValveinvalveTechniken refers to transcatheter procedures in which a transcatheter heart valve is implanted within a previously implanted bioprosthetic valve that has degenerated. The goal is to restore valve function while avoiding redo surgery through sternotomy. By treating stenosis, regurgitation, or mixed dysfunction, ViV techniques aim to reduce symptoms and improve hemodynamics in patients at higher surgical risk.

Indications include symptomatic dysfunction of a degenerated bioprosthetic valve after prior surgery, particularly in patients with high perioperative risk or limited life expectancy where redo surgical valve replacement would be hazardous. Anatomical suitability, coronary ostia height, and access routes after valve-in-valve are assessed during planning.

Planning relies on multimodality imaging, especially CT, to determine the inner diameter of the failed valve, valve type, and the risk of coronary obstruction. Transcatheter valves used for ViV are generally balloon-expandable or self-expanding devices sized to fit the internal frame. Common access is transfemoral, with alternatives such as transapical or direct aortic approaches in selected cases.

In some situations, the bioprosthetic valve fracture technique may be employed to fracture the surgical frame with high-pressure ballooning to allow better expansion of the transcatheter valve and reduce patient-prosthesis mismatch. Prevention of coronary obstruction may involve techniques such as chimney stenting of the coronary arteries during deployment.

Early and mid-term outcomes from experienced centers show meaningful symptom relief and favorable survival in appropriately selected patients, though risks include residual paravalvular leak, coronary obstruction, vascular complications, stroke, and the potential need for a pacemaker after implantation. Durability data continue to evolve, and long-term expectations depend on device selection, anatomy, and institutional expertise.