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Tosaka K, Ninomiya R, Fusazaki T, Morino Y. Infolding of Evolut PRO+ during transcatheter aortic valve implantation and bailout by post-balloon dilation: A case report. J Cardiol Cases 2024; 29:190-192. [PMID: 38646073 PMCID: PMC11031665 DOI: 10.1016/j.jccase.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/25/2023] [Accepted: 12/26/2023] [Indexed: 04/23/2024] Open
Abstract
An 89-year-old man with symptomatic severe aortic stenosis underwent transcatheter aortic valve implantation due to old age and a history of coronary artery bypass grafting. Computed tomography showed a tricuspid aortic valve and severe calcification at the aortic valve annulus, with a perimeter of 88.7 mm. The 34-mm Evolut PRO+ (Medtronic Inc., Minneapolis, MN, USA) was selected. After balloon aortic valvuloplasty, deployment of the Evolut PRO+ was attempted, but significant expansion failure was observed. Upon retraction and removal of the Evolut PRO+ from the body, frame deformation was observed. A new Evolut PRO+ was tried again, but a similar finding was noted as a magatama-like infolding on transesophageal echocardiography. Fortunately, the patient's hemodynamics were relatively stable. Post-dilation was performed using a 25 mm Z-MED II (NuMED, Inc., Montreal, Canada) for reshaping. Learning objective In self-expanding transcatheter aortic valves (TAVs), bending of the TAV frame is widely known as one of the key problems. However, this is rare and infrequently encountered. In this case, TAV frame infolding occurred repeatedly, and the morphology of the infolding was evaluated in vitro and in vivo. Furthermore, we report that some TAVs can be reshaped by post-dilation.
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Affiliation(s)
- Kengo Tosaka
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Ryo Ninomiya
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Tetsuya Fusazaki
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
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Yashige M, Zen K, Takamatsu K, Matoba S. Additional balloon aortic valvuloplasty to overcome the difficult removal of a self-expandable transcatheter aortic valve system due to valve infolding. Catheter Cardiovasc Interv 2022; 100:1331-1335. [PMID: 36259731 DOI: 10.1002/ccd.30444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/20/2022] [Accepted: 10/08/2022] [Indexed: 01/04/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is a well-established treatment for severe aortic stenosis. Advances in the devices used and operators' technique have reduced the frequency of complications. However, valve infolding is a rare but serious outcome after the implantation of self-expanding prostheses. We report a case of a successful bailout of a device that was difficult to remove because of valve infolding. TAVR using a 26 mm Evolut PRO+ system (Medtronic) was planned for a 91-year-old woman with severe aortic stenosis. After the valve was deployed in a satisfactory position on the second release, the system could not be removed because the nose cone was hooked to the basal frame of the deployed valve. To overcome this situation, an additional balloon was inserted from the contralateral femoral side and inflated, and we extracted the system successfully by pulling out the device while simultaneously deflating the balloon. Postoperative computed tomography revealed valve infolding, which was considered to cause the difficulty in system removal. Infoldings of self-expandable prostheses should be considered when faced with difficulty in removing the catheter system, and the method elucidated in this case report can be effective to manage it.
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Affiliation(s)
- Masaki Yashige
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuaki Takamatsu
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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McInerney A, Vera-Urquiza R, Tirado-Conte G, Marroquin L, Jimenez-Quevedo P, Nuñez-Gil I, Pozo E, Gonzalo N, de Agustín JA, Escaned J, Fernández-Ortiz A, Macaya C, Nombela-Franco L. Pre-dilation and Post-dilation in Transcatheter Aortic Valve Replacement: Indications, Benefits and Risks. Interv Cardiol 2021; 16:e28. [PMID: 34721667 PMCID: PMC8532006 DOI: 10.15420/icr.2020.35] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/17/2021] [Indexed: 12/12/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is an established treatment for patients with symptomatic severe aortic stenosis. In recent years, an emphasis has been placed on simplification of the procedure. Balloon predilation was initially considered a mandatory step to cross and prepare the stenotic aortic valve, but several studies demonstrated the feasibility of performing TAVR without balloon valvuloplasty. Balloon postdilation of the implanted valve is sometimes required to optimise results, although many patients do not require this step. Contemporary consensus advocates an individualised approach to TAVR procedures and so balloon pre- and post-dilation are performed selectively. This review aims to outline the advantages and disadvantages of balloon pre- and post-dilation and to identify the scenarios in which they are required during TAVR procedures.
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Affiliation(s)
- Angela McInerney
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | | | | | - Luis Marroquin
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | | | - Iván Nuñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | - Eduardo Pozo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | - Nieves Gonzalo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | | | - Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
| | | | - Carlos Macaya
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC Madrid, Spain
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Ancona MB, Beneduce A, Romano V, Buzzatti N, Russo F, Bellini B, Ferri LA, Agricola E, Landoni G, Scandroglio AM, Chieffo A, Montorfano M. Self-expanding transcatheter aortic valve infolding: Current evidence, diagnosis, and management. Catheter Cardiovasc Interv 2020; 98:E299-E305. [PMID: 33315300 DOI: 10.1002/ccd.29432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/10/2020] [Accepted: 11/30/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Prosthetic valve infolding is a rare but severe complication of transcatheter aortic valve implantation (TAVI) with self-expanding valves. However, currently available clinical data are limited and fragmented. OBJECTIVES This report aims to provide a comprehensive overview of this complication focusing on predisposing factors, clinical presentation, diagnostic findings, treatment and clinical outcomes. METHODS A systematic review of the literature was performed to identify cases of infolding occurring during TAVI with self-expanding valves published until August 2020. These data were pooled with all the retrospectively identified infolding cases occurred at San Raffaele Scientific Institute between December 2014 and August 2020. RESULTS A total of 34 cases were included. Among patients with available data, 38% received a first-generation CoreValve, and 62% a second-generation Evolut R (82%) or Evolut PRO (18%). Infolding occurred mostly with ≥29-mm valves (94%). Predisposing factors included resheathing of a second-generation valve (82%), heavy calcification of the native valve (65%), lack of predilatation (16%), Sievers type-1 bicuspid aortic valve (11%), and improper valve loading (5%). Infolding resulted in severe PVL causing hemodynamic instability (29%) or cardiac arrest (12%). Postdilatation was the treatment strategy in 68%, while prosthesis replacement with a new device in 23% of cases. Device success rate was 82%. Death and stroke occurred in 3% and 12% of cases. CONCLUSIONS Prosthetic valve infolding is typically observed after resheathing of a large-size self-expanding TAVI. When infolding is timely diagnosed, prosthesis removal and replacement should be pursued. Further studies are required to precisely define predisposing factors to prevent this complication.
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Affiliation(s)
- Marco Bruno Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Beneduce
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Romano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Cardiac Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Angelo Ferri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Echocardiography Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Mara Scandroglio
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Singh G, Le V, Wiechmann RJ, Schreiter SW. Self-Expandable Transcatheter Aortic Valve Frame Infolding: An Increasingly Recognized Complication. Eur J Case Rep Intern Med 2020; 7:002100. [PMID: 33585329 DOI: 10.12890/2020_002100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/14/2020] [Indexed: 11/05/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) with either a balloon-expandable or a self-expandable transcatheter heart valve (THV) is an approved therapy for patients with symptomatic severe aortic stenosis and high or intermediate surgical risk. Here we present a case of severe valve frame infolding of a CoreValve Evolut PRO® self-expandable THV (Medtronic Inc.), which was restored to optimal geometry with balloon post-dilation. LEARNING POINTS Clinicians should be aware of the rare complication of frame infolding during deployment of a self-expanding transcatheter valve.Multimodality cardiac imaging is important to optimize transcatheter valve deployment.
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Affiliation(s)
- Gurpreet Singh
- Department of Cardiovascular Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Vien Le
- Department of Cardiovascular Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Robert J Wiechmann
- Department of Cardiovascular Surgery, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Steven W Schreiter
- Department of Cardiovascular Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
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Musallam A, Rogers T, Ben-Dor I, Torguson R, Khan JM, Satler LF, Waksman R. Self-Expanding Transcatheter Aortic Valve-Frame Infolding: A Case Series With a Warning Message. JACC Cardiovasc Interv 2020; 13:789-790. [PMID: 32192702 DOI: 10.1016/j.jcin.2019.11.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022]
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Karrowni W, Fakih S, Nassar P. Infolding of Self-Expandable Transcatheter Heart Valve: Case Report and Review of Literature. Cureus 2020; 12:e10093. [PMID: 33005514 PMCID: PMC7522173 DOI: 10.7759/cureus.10093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Transcutaneous aortic valve replacement (TAVR) has become a widely accepted minimally invasive approach for treatment of severe aortic stenosis. Self-expandable prostheses are commonly the device of choice, with excellent procedural success and durability. However, there have been several recent case reports of infolding of the self-expandable prosthesis during development with subsequent malfunction and need for further intervention. We present a case of self-expandable valve prosthesis infolding managed by balloon postdilation, and summarize the cases reported in the literature to date in an attempt to increase awareness of this serious technical problem and the factors associated with it.
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Vasu N, Chopra A, Rao RS, Ajit MS. Infolding of a self-expanding bioprosthesis due to loss of nitinol memory during transcatheter aortic valve implantation. EUROINTERVENTION 2020; 16:e301-e302. [DOI: 10.4244/eij-d-20-00204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Stent Frame Infolding of a 34-mm Evolut-R in a Patient With a Mechanical Mitral Valve. JACC Cardiovasc Interv 2020; 13:e25-e27. [DOI: 10.1016/j.jcin.2019.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 09/23/2019] [Accepted: 10/01/2019] [Indexed: 11/24/2022]
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