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Bittira B, Shurrab M, Santi S, Grieve S, MacDonald DJ. Intermediate-term Outcomes Following a Case Series of Reoperations for Medtronic Freestyle Stentless Aortic Valves. CJC Open 2023; 5:793-797. [PMID: 38020335 PMCID: PMC10679463 DOI: 10.1016/j.cjco.2023.08.008] [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] [Received: 05/27/2023] [Accepted: 08/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Data are limited on long-term outcomes in patients who have undergone a reoperation following failure of a stentless aortic valve. Methods Between 2006 and 2016, a retrospective analysis was performed on 24 patients who underwent open aortic valve replacement surgery for a failed stentless aortic valve prosthesis at Health Sciences North, Sudbury, Ontario, Canada. The primary outcome was a low mortality rate from cardiac-related deaths after 5 years. Results All patients underwent insertion of a Medtronic Freestyle bioprosthesis (Minneapolis, MN) implanted using the modified subcoronary technique for their initial operation. The interval from the first operation to the stentless redo surgery ranged from 6 to 13 years. Aortic valve reoperation was performed for structural valve deterioration in 96% (n = 23) of the cases. Reoperations involved a removal of the stented valve leaflets and standard aortic valve replacement within the stentless casing in 20% (n = 5) of the cases, with the remaining cases requiring complete removal of the stentless prosthesis and aortic valve replacement. In those in whom a complete removal of the stentless valve was possible (n = 19), no disruption of the native aortic root occurred, with a 0% rate of conversion to a Bentall procedure. No intraoperative mortality occurred. The 30-day and 10-year operative mortality rates were 4% and 16%, respectively. Conclusions Redo surgery for failing stentless valves can be done with relatively low risk and with acceptable long-term outcomes without resorting to root-replacement techniques.
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Affiliation(s)
- Bindu Bittira
- Division of Cardiac Surgery, Department of Surgery, Health Sciences North, Sudbury, Ontario, Canada
| | - Mohammed Shurrab
- Department of Cardiology, Health Sciences North, Sudbury, Ontario, Canada
| | - Stacey Santi
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
| | - Sarah Grieve
- Division of Cardiac Surgery, Department of Surgery, Health Sciences North, Sudbury, Ontario, Canada
| | - Derek J. MacDonald
- Division of Cardiac Surgery, Department of Surgery, Health Sciences North, Sudbury, Ontario, Canada
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Lang FM, Mihatov N, Kriegel J, Nazif TM, Vahl TP, Ng VG, Lebehn M, Blusztein D, Cahill TJ, Lehenbauer KR, Hahn RT, Leon M, Kodali SK, George I. Transcatheter aortic valve-in-valve implantation within stentless landing zones: Procedural insights from a single-center experience. Catheter Cardiovasc Interv 2023. [PMID: 37393603 DOI: 10.1002/ccd.30755] [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: 11/22/2022] [Revised: 04/18/2023] [Accepted: 06/11/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Valve-in-valve (VIV) transcatheter aortic valve implantation (TAVI) is a less invasive therapeutic option compared with redo surgical valve replacement for high-risk patients. Relative to procedures within stented surgical valves, VIV-TAVI within stentless valves is associated with a higher complication rate due to challenging underlying anatomy and absence of fluoroscopic landmarks. AIMS We share a single-center experience with VIV-TAVI in stentless valves, discussing our procedural insights and associated outcomes. METHODS Our institutional database was queried, and 25 patients who had undergone VIV-TAVI within a stentless bioprosthesis, homograft, or valve-sparing aortic root replacement between 2013 and 2022 were found. Outcome endpoints were based on the Valve Academic Research Consortium-3 criteria. RESULTS The mean age of the cohort was 69.5 ± 13.6 years. VIV implantation was performed within a homograft in 11 patients, a stentless bioprothesis in 10 patients, and a valve-sparing aortic root replacement in 4 patients. Nineteen (76%) balloon-expandable valves, 5 (20%) self-expanding valves, and one mechanically-expandable (4%) valve were implanted with 100% procedural success, with no instances of significant paravalvular leak, coronary occlusion, or device embolization. There was one (4%) in-hospitality mortality after an emergency procedure; one (4%) patient experienced a transient ischemic attack; and two (8%) patients required permanent pacemaker implantation. The median length of hospital stay was 2 days. After a median follow-up time of 16.5 months, valve function was acceptable in all patients with available data. CONCLUSION VIV-TAVI within stentless valves can be safely performed with methodical procedural technique and can provide clinical benefit in patients at high reoperation risk.
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Affiliation(s)
- Frederick M Lang
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Nino Mihatov
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Jacob Kriegel
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Tamim M Nazif
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Torsten P Vahl
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Vivian G Ng
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Mark Lebehn
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - David Blusztein
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Thomas J Cahill
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Kyle R Lehenbauer
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Rebecca T Hahn
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Martin Leon
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Susheel K Kodali
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Isaac George
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
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Gustafson S, Kulkarni A, Galper B, Berry N. Sequential transcatheter aortic and pulmonic valve replacement in bioprosthetic valve dysfunction: a case report. Eur Heart J Case Rep 2023; 7:ytad170. [PMID: 37090755 PMCID: PMC10117369 DOI: 10.1093/ehjcr/ytad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/20/2022] [Accepted: 04/03/2023] [Indexed: 04/25/2023]
Abstract
Background Transcatheter valve replacement is a less invasive alternative to surgical valve replacement and has become increasingly popular. It is often the preferred approach for patients with high surgical risk. In patients with multiple prior sternotomies and multi-valvular failure, sequential transcatheter valve replacements may be a viable option. Case summary We present the case of a 61-year-old-man with two prior sternotomies who underwent sequential transcatheter replacements of the aortic and pulmonic valves for symptomatic aortic and pulmonary stenosis. He was deemed high risk for a repeat sternotomy. The decision to perform sequential transcatheter aortic valve replacement (TAVR) and transcatheter pulmonic valve replacement (TPVR) a month apart was made. Patient underwent valve-in-valve TAVR in a stentless bioprosthetic valve with 29-mm Edwards Sapien 3 followed by TPVR with 26-mm Edwards Sapien 3. He tolerated both procedures well and was asymptomatic at 1-month follow up. Discussion To our knowledge, this is the first reported successful case of sequential TAVR and TPVR with right ventricular outflow tract stenting in a patient with both aortic and pulmonic bioprosthetic valve dysfunction. Our case demonstrates that transcatheter approach to multi-valvular replacements may be a viable option for high-risk surgical patients.
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Affiliation(s)
| | - Ameya Kulkarni
- Department of Cardiology, Mid-Atlantic Permanente Medical Group, 8008 Westpark Dr, McLean, VA 22102, USA
| | - Benjamin Galper
- Department of Cardiology, Mid-Atlantic Permanente Medical Group, 8008 Westpark Dr, McLean, VA 22102, USA
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Cekmecelioglu D, Preventza O, Dougherty KG, Chatterjee S, Green SY, Silva GV, Díez JG, Coselli JS. Transcatheter valve-in-valve implantation for degenerated stentless aortic bioroots. Ann Cardiothorac Surg 2021; 10:641-650. [PMID: 34733691 DOI: 10.21037/acs-2021-tviv-124] [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: 07/10/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022]
Abstract
Background Open surgical repair of a failed valve-sparing aortic root replacement (VSARR) or stentless bioroot aortic root replacement (bio-ARR) entails significant operative risks. Whether valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is feasible in patients with a previous VSARR or stentless bio-ARR remains unclear, given lingering concerns about the ill-defined aortic annulus in these patients and the potential for coronary obstruction. We present our experience with patients who had a previous VSARR or stentless bio-ARR and underwent ViV-TAVR to repair a degenerated aortic valve with combined valvular disease, aortic insufficiency and aortic stenosis. Methods In this retrospective data review, we identified and analyzed consecutive patients with a previous VSARR or stentless bio-ARR who underwent ViV-TAVR between December 1, 2014 and August 31, 2019. Results ViV-TAVR was performed in twelve high-risk patients with previous VSARR or bio-ARR during the study period. Of these, seven received Medtronic Freestyle porcine stentless bioprosthetic aortic roots, three received homograft aortic roots, one underwent a Ross procedure and one underwent VSARR. ViV-TAVR restored satisfactory valve function in all patients, and technical success was 100%. No patient had more than mild regurgitation after implantation. No thirty-day mortality was seen. One patient had major bleeding after transapical access, one patient had a transient ischemic stroke, and one patient needed permanent pacemaker implantation. At a median last follow-up of 21.5 months (interquartile range, 9.0-69.0 months), all patients remained alive and had satisfactory valve function. Conclusions In this study, ViV-TAVR was a clinically effective option for treating patients with a failed stentless bio-ARR or previous VSARR. Short-term and intermediate-term results after these procedures were favorable. These findings may have important implications for treating high-risk patients with structural aortic root deterioration and call for better transcatheter heart valves that are suitable for treating aortic insufficiency.
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Affiliation(s)
- Davut Cekmecelioglu
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Kathryn G Dougherty
- Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Subhasis Chatterjee
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA.,Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College Medicine, Houston, Texas, USA
| | - Susan Y Green
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Office of Surgical Research, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Guilherme V Silva
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jose G Díez
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiology, Texas Heart Institute, Houston Texas, USA
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
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Burgdorf C, Vukadinovikj Momchilovska A, Remppis BA. Outcomes after transcatheter valve-in-valve implantation using a balloon-expandable Edwards Sapien valve in patients with degenerated Freestyle aortic bioprosthesis. Ann Cardiothorac Surg 2021; 10:667-673. [PMID: 34733694 DOI: 10.21037/acs-2021-tviv-fs-43] [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: 03/24/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022]
Abstract
Background Transcatheter aortic valve-in-valve implantation (ViV TAVI) in degenerated Medtronic Freestyle aortic bioprosthesis (FSB) has been reported as being technically challenging. This study sought to evaluate procedural data and outcomes after ViV TAVI using a balloon-expandable Edwards valve in patients with failed FSB. Methods Between August 2014 and December 2020, twenty-seven consecutive patients underwent ViV TAVI for symptomatic FSB failure at our institution using a Sapien XT (n=1) and Sapien 3 (n=26) valve, respectively. Endpoints were defined according to the Valve Academic Research Consortium-2 (VARC-2) criteria and were retrospectively analyzed. Results Mean patient age was 75.7±8.2 years (female n=5, male n=22); Society of Thoracic Surgeons Predicted Risk of Mortality score was 7.3%±6.2%. ViV implantation with correct positioning of the Edwards Sapien valve within the FSB was successful in all cases. Intraprocedural transesophageal echocardiography revealed none/trace paravalvular regurgitation in twenty-five patients (92.6%), mild paravalvular regurgitation was present in two patients (7.4%). Neither of the patients had a mean gradient ≥20.0 mmHg excluding significant patient-prosthesis mismatch. Three early deaths (≤thirty days) occurred resulting in a device success rate of 88.8%. One-year and three-year survival rates for patients alive beyond day thirty after ViV TAVI were 95.8% and 70.0%, respectively. Conclusions ViV TAVI with Edwards Sapien valves lead to acceptable functional results in high-risk patients with degenerated FSB but early complications must be considered particularly during hospital stay.
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Affiliation(s)
- Christof Burgdorf
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Germany
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Elzanaty AM, Mahmood M, Mhanna M, Nazir S, Letcher J, Yenrick K, Boonie E, Kasi Ramanathan P. Transesophageal echocardiogram to guide valve-in-valve transcatheter aortic valve replacement of a failed Medtronic-freestyle aortic prosthesis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40S:190-195. [PMID: 34507911 DOI: 10.1016/j.carrev.2021.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 11/19/2022]
Abstract
Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) is an appealing alternative to surgical intervention on failed aortic prosthesis with comparable safety and efficacy. ViV TAVR has proven to be a technical challenge in stentless bioprosthetic aortic valves like free style aortic valve prosthesis. In this case series of two patients we report the utility of transesophageal echocardiogram guidance to help visualize surgical annulus and TAVR deployment.
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Affiliation(s)
- Ahmed Mohamed Elzanaty
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, United States of America
| | - Mohammed Mahmood
- Department of Internal Medicine, University of Toledo, Toledo, OH, United States of America
| | - Mohamed Mhanna
- Department of Internal Medicine, University of Toledo, Toledo, OH, United States of America
| | - Salik Nazir
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, United States of America
| | - John Letcher
- Heart and Vascular Institute, Promedica Toledo Hospital, Toledo, OH, United States of America
| | - Kellie Yenrick
- Heart and Vascular Institute, Promedica Toledo Hospital, Toledo, OH, United States of America
| | - Erica Boonie
- Heart and Vascular Institute, Promedica Toledo Hospital, Toledo, OH, United States of America
| | - P Kasi Ramanathan
- Heart and Vascular Institute, Promedica Toledo Hospital, Toledo, OH, United States of America.
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Reich H, Roselli EE. Defining the Limits of Valve-in-Valve Transcatheter Aortic Valve Replacement for Degenerated Freestyle Bioprosthesis. Ann Thorac Surg 2020; 110:1957-1958. [PMID: 32585205 DOI: 10.1016/j.athoracsur.2020.04.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Heidi Reich
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195.
| | - Eric E Roselli
- Aorta Center, Aortic Valve Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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