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Evidence to Improve Care

Transcatheter Valve-in-Valve Implantation for Degenerated Mitral or Tricuspid Bioprosthetic Valves

Final Recommendation

  • Ontario Health, based on guidance from the Ontario Health Technology Advisory Committee, recommends publicly funding transcatheter valve-in-valve implantation for adults with degenerated mitral or tricuspid bioprosthetic valves who are considered inoperable or high-risk for surgery

Read the final recommendation report

Heart valve disease can occur in any of the four valves of the heart (pulmonary, mitral, aortic, or tricuspid), and it can lead to heart failure. The most common treatment for heart valve disease is open-heart surgery to replace the damaged valve with an artificial one. However, a common type of artificial valve, called a bioprosthetic valve, lasts only about 10 to 15 years.

Transcatheter valve-in-valve implantation is a less invasive treatment for people whose first bioprosthetic valve is failing and who cannot have another surgery or are at high risk for a poor outcome from another open-heart surgery. With transcatheter valve-in-valve implantation, cardiologists insert a catheter (a tube) into a large vein and thread the new valve through the vein, up into the heart. The new valve is placed inside the old valve, and it pushes the old valve out of the way.

This health technology assessment looked at how safe and effective transcatheter valve-in-valve implantation is for adults with failing mitral or tricuspid bioprosthetic valves who cannot have surgery or are high-risk for surgery. It also looked at the budget impact of publicly funding transcatheter valve-in-valve implantation. And it considered the experiences, preferences, and values of adults with failing mitral or tricuspid bioprosthetic valves.

Read the full Health Technology Assessment report for more information.

Transcatheter Valve-in-Valve Implantation for Degenerated Mitral or Tricuspid Bioprosthetic Valves: A Health Technology Assessment
January 2022

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The Ministry of Health has accepted this recommendation.

The Ministry of Health has provided the following response: The Ministry has a standardized process in place to review health technology assessments and funding recommendations. This takes into consideration Ministry priorities, implementation options, the need for consultation with impacted stakeholders, and funding considerations.

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