In the last few years transcatheter aortic valve replacements from Edwards Lifesciences and Medtronic have entered the marketplace and now offer an alternative to surgery for some patients. Now these valves are being considered for use in patients who have already undergone surgery but whose bioprosthetic valves have failed.
Although surgeons and patients increasingly prefer bioprosthetic valves to mechanical valves, the chief drawback to the bioprosthetic valves is that they may eventually deteriorate, which means that more and more physicians and patients will inevitably be faced with the dilemma of how best to treat degenerated valves. Although surgical reoperation is considered the best solution, many patients are too old and frail for surgery. Transcatheter aortic valve implantation (TAVI) has been proposed for use in this situation, though the risks and benefits have not as yet been well defined.
Now, a new study in JAMA provides information on 459 patients with failed bioprosthetic valves who underwent TAVI with either the Edwards Sapien device or the Medtronic Corevalve device.
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