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Matsuda M, Maeda K, Shimamura K, Yamashita K, Kawamura A, Yoshioka D, Miyagawa S. A Case of TAV-in-SAV in a Patient with Structural Valve Deterioration after Surgical Aortic Valve Replacement with the INSPIRIS RESILIA Valve. Ann Thorac Cardiovasc Surg 2024; 30:22-00083. [PMID: 36002299 PMCID: PMC10851443 DOI: 10.5761/atcs.cr.22-00083] [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: 05/16/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
The INSPIRIS RESILIA valve is designed to dilate its valve annulus in transcatheter aortic valve-in-surgical aortic valve (TAV-in-SAV), a catheter therapy for biological valve deterioration. RESILIA tissue has improved anti-calcification properties. An 83-year-old man on hemodialysis undergoing surgical aortic valve replacement (SAVR) with a 25-mm INSPIRIS for severe aortic stenosis 22 months ago presented with general malaise. Transthoracic echocardiography revealed severe bioprosthetic stenosis (peak velocity: 3.5 m/s, mean pressure gradient: 32 mmHg, and effective orifice area: 0.45 cm2) and severely reduced left ventricular function (ejection fraction: 17%). Because redo-SAVR was extremely risky (society of thoracic surgeons [STS] risk score: 31%), the patient underwent transfemoral-TAV-in-SAV using a 26-mm SAPIEN 3️. Pre- and postoperative computed tomography showed that the internal diameter of the INSPIRIS had expanded from 22.2 mm to 24.2 mm. This case demonstrated the dilatable design of INSPIRIS but not the durability of RESILIA tissue.
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Affiliation(s)
- Masaru Matsuda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Koichi Maeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kizuku Yamashita
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Wang X, Lu Y, Liu Z, Rubino AS, Perek B, Wendt D, Pisano C, Goudot G, Deutsch O, Liu X. Transcatheter aortic valve replacement in the management of aortic insufficiency secondary to left ventricular assist device implantation: a case report. J Thorac Dis 2023; 15:7130-7139. [PMID: 38249889 PMCID: PMC10797376 DOI: 10.21037/jtd-23-1642] [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: 10/27/2023] [Accepted: 12/08/2023] [Indexed: 01/23/2024]
Abstract
Background Left ventricular assist device (LVAD) is considered either a destination therapy for patients with end-stage heart failure or heart transplantation bridging. LVAD implantation often causes aortic insufficiency (AI), which requires aortic valve repair. However, severe acute AI does not respond well to medication, and re-operation means higher risk to the patients; the most effective therapeutic strategies for LVAD-induced AI still need further exploration. In this report, we present the first described case of new-onset, severe LVAD-induced AI in China with a patient who underwent transcatheter aortic valve replacement (TAVR) and achieved significant improvement in functional capacity and symptoms with lower operation risk. Case Description A 55-year-old male patient was diagnosed with dilated cardiomyopathy for 14 years. The effect of the medication gradually deteriorated, LVAD (HeartCon®) was implanted one year earlier. The patient complained of intermittent chest tightness for one week, which had been aggravated for two days before hospitalization. Echocardiographic findings revealed new-onset, severe LVAD-induced AI. TAVR was performed with a self-expandable stent-valve (TAV30, Vitaflow Liberty). Within minutes, the patient recovered with rapid disappearance of chest tightness and stable vital signs. Before discharge, the position of the artificial valve was fixed without incomplete closure nor thrombus attachment, yielding a left ventricular ejection fraction (LVEF) of 35%. The patient was hospitalized for 38 days, and followed up with outpatient treatment, the condition was stable until 19 June 2023. Conclusions TAVR could be an effective, safe, and less invasive means of restoring ejection fraction for patients with a LVAD who develop severe AI.
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Affiliation(s)
- Xiaodong Wang
- Cardiovascular Department, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Yujie Lu
- Cardiovascular Department, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Zhigang Liu
- Cardiac Surgery, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Antonino S. Rubino
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AORN dei Colli, Cardiac Surgery, Vincenzo Monaldi Hospital, Naples, Italy
| | - Bartlomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, Westgerman Heart and Vascular Center, Essen, Germany
| | - Calogera Pisano
- Cardiac Surgery Unit, Department of Surgical Science, Tor Vergata University Hospital, Rome, Italy
| | - Guillaume Goudot
- Vascular Medicine Department, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, INSERM U970 PARCC, Paris, France
| | - Oliver Deutsch
- Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany
| | - Xiaocheng Liu
- Cardiac Surgery, TEDA International Cardiovascular Hospital, Tianjin, China
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Wilbring M, Kappert U, Haussig S, Winata J, Matschke K, Mangner N, Arzt S, Alexiou K. Hemodynamic follow-up after valve-in-valve TAVR for failed aortic bioprosthesis. J Card Surg 2022; 37:4654-4661. [PMID: 36273424 DOI: 10.1111/jocs.17048] [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: 07/19/2022] [Revised: 08/31/2022] [Accepted: 10/05/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND "valve-in-valve" TAVR (VIV-TAVR) is established and provides good initial clinical and hemodynamic outcomes. Lacking long-term durability data baffle the expand to lower risk patients. For those purposes, the present study adds a hemodynamic 3-years follow-up. METHODS A total of 77 patients underwent VIV-TAVR for failing aortic bioprosthesis during a 7-years period. Predominant mode of failure was stenosis in 87.0%. Patients had a mean age of 79.4 ± 5.8 years and a logistic EuroSCORE of 30.8 ± 15.7%. The Society of Thoracic Surgeons-PROM averaged 5.79 ± 2.63%. Clinical results and hemodynamic outcomes are reported for 30-days, 1-, 2-, and 3-years. Completeness of follow-up was 100% with 44 patients at risk after 3-years. Follow-up ranged up to 7.1 years. RESULTS Majority of the surgical valves were stented (94.8%) with a mean labeled size of 23.1 ± 2.3 mm and true-ID of 20.4 ± 2.6 mm. A true-ID ≤21 mm had 58.4% of the patients. Self-expanding valves were implanted in 68.8% (mean labeled size 24.1 ± 1.8 mm) and balloon-expanded in 31.2% (mean size 24.1 ± 1.8 mm). No patient died intraoperatively. Hospital mortality was 1.3% and three-years survival 57.1%. All patients experienced an initial significant dPmean-reduction to 16.8 ± 7.1 mmHg. After 3-years mean dPmean raised to 26.0 ± 12.2 mmHg. This observation was independent from true-ID or type of transcatheter aortic valve replacement (TAVR)-prosthesis. Patients with a true-ID ≤21 mm had a higher initial (18.3 ± 5.3 vs. 14.9 ± 7.1 mmHg; p = .005) and dPmean after 1-year (29.2 ± 8.2 vs. 13.0 ± 6.7 mmHg; p = .004). There were no significant differences in survival. CONCLUSIONS VIV-TAVR is safe and effective in the early period. In surgical valves with a true-ID ≤21 mm inferior hemodynamic and survival outcomes must be expected. Nonetheless, also patients with larger true-IDs showed steadily increasing transvalvular gradients. This raises concern about durability.
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Affiliation(s)
- Manuel Wilbring
- Medical Faculty "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Department for Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Utz Kappert
- Medical Faculty "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Department for Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Stephan Haussig
- Medical Faculty "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Department for Cardiology, University Heart Center Dresden, Dresden, Germany
| | - Johan Winata
- Medical Faculty "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Department for Cardiac Anesthesiology, University Heart Center Dresden, Dresden, Germany
| | - Klaus Matschke
- Medical Faculty "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Department for Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Norman Mangner
- Medical Faculty "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Department for Cardiology, University Heart Center Dresden, Dresden, Germany
| | - Sebastian Arzt
- Medical Faculty "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Department for Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Konstantin Alexiou
- Medical Faculty "Carl Gustav Carus", TU Dresden, Dresden, Germany.,Department for Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
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