Balloon Fracturing Valve-in-Valve: How to Do It and a Case Report of TAVR in a Rapid Deployment Prosthesis.

HEART valve prosthesis implantation; BIOPROSTHETIC heart valves; HEART valves; PROSTHETICS; AORTIC valve surgery; AORTIC stenosis; ARTIFICIAL implants; TREATMENT effectiveness; PROSTHETIC heart valves; PROSTHESIS design & construction; COMPLICATIONS of prosthesis

Transcatheter aortic valve replacement (TAVR) to treat degeneration of bioprosthetic heart valves (BHVs), called as valve-in-valve (ViV), is becoming a key feature since the number of BHVs requiring intervention is increasing and many patients are at high risk for a redo cardiac surgery. However, a TAVR inside a small previous cardiac valve may lead to prosthesis-patient mismatch (PPM) and not be as effective as we hoped for. An effective option to decrease the chance of PPM is to fracture the previous heart valve implanted using a high-pressure balloon. By performing a valve fracture, the inner valve ring of small BHVs can be opened up by a single fracture line, allowing subsequent implantation of a properly sized transcatheter heart valve, without increasing substantially the procedure risk. In this article, we provide a step-by-step procedure on how to safely and properly fracture a BHV and report a case of a TAVR in a degenerated rapid deployment valve. [ABSTRACT FROM AUTHOR]