Bioprosthetic Valve Fracture: A Practical Guide to Facilitate Valve-In-Valve TAVR

Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) is approved by the FDA in patients at high surgical risk and increasingly utilized by heart teams as an alternative to reoperation for failing surgical tissue valves. Optimizing transcatheter heart valve (THV) expansion and decreasing the risk of patient-prosthesis mismatch are important concerns when performing VIV TAVR, particularly in small surgical valves. Bioprosthetic valve fracture (BVF) and bioprosthetic valve remodeling (BVR) are techniques to facilitate VIV TAVR in which a high-pressure inflation with a non-compliant balloon is performed to either fracture or stretch the surgical valve ring allowing for a more optimal expansion of the THV and reducing the potential for high residual transvalvular gradients. This article, along with the supplemental video, will provide a practical guide to performing BVF and BVR.