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Di Muro FM, Cirillo C, Esposito L, Silverio A, Ferruzzi GJ, D’Elia D, Formisano C, Romei S, Vassallo MG, Di Maio M, Attisano T, Meucci F, Vecchione C, Bellino M, Galasso G. Valve-in-Valve Transcatheter Aortic Valve Replacement: From Pre-Procedural Planning to Procedural Scenarios and Possible Complications. J Clin Med 2024; 13:341. [PMID: 38256475 PMCID: PMC10816632 DOI: 10.3390/jcm13020341] [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: 11/23/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Over the last decades, bioprosthetic heart valves (BHV) have been increasingly implanted instead of mechanical valves in patients undergoing surgical aortic valve replacement (SAVR). Structural valve deterioration (SVD) is a common issue at follow-up and can justify the need for a reintervention. In the evolving landscape of interventional cardiology, valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has emerged as a remarkable innovation to address the complex challenges of patients previously treated with SAVR and has rapidly gained prominence as a feasible technique especially in patients at high surgical risk. On the other hand, the expanding indications for TAVR in progressively younger patients with severe aortic stenosis pose the crucial question on the long-term durability of transcatheter heart valves (THVs), as patients might outlive the bioprosthetic valve. In this review, we provide an overview on the role of ViV TAVR for failed surgical and transcatheter BHVs, with a specific focus on current clinical evidence, pre-procedural planning, procedural techniques, and possible complications. The combination of integrated Heart Team discussion with interventional growth curve makes it possible to achieve best ViV TAVR results and avoid complications or put oneself ahead of time from them.
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Affiliation(s)
- Francesca Maria Di Muro
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Clinica Medica, Careggi University Hospital, 50134 Florence, Italy; (F.M.D.M.); (F.M.)
| | - Chiara Cirillo
- Oxford Heart Centre, Oxford University Trust, Oxford OX3 9DU, UK
| | - Luca Esposito
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salvador Allende Street 43, 84081 Salerno, Italy; (L.E.); (C.F.); (S.R.); (G.G.)
- Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salvador Allende Street 43, 84081 Salerno, Italy; (L.E.); (C.F.); (S.R.); (G.G.)
| | - Germano Junior Ferruzzi
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salvador Allende Street 43, 84081 Salerno, Italy; (L.E.); (C.F.); (S.R.); (G.G.)
| | - Debora D’Elia
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salvador Allende Street 43, 84081 Salerno, Italy; (L.E.); (C.F.); (S.R.); (G.G.)
| | - Ciro Formisano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salvador Allende Street 43, 84081 Salerno, Italy; (L.E.); (C.F.); (S.R.); (G.G.)
| | - Stefano Romei
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salvador Allende Street 43, 84081 Salerno, Italy; (L.E.); (C.F.); (S.R.); (G.G.)
| | - Maria Giovanna Vassallo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salvador Allende Street 43, 84081 Salerno, Italy; (L.E.); (C.F.); (S.R.); (G.G.)
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salvador Allende Street 43, 84081 Salerno, Italy; (L.E.); (C.F.); (S.R.); (G.G.)
| | - Tiziana Attisano
- Division of Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi d’ Aragona University Hospital, 84131 Salerno, Italy;
| | - Francesco Meucci
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Clinica Medica, Careggi University Hospital, 50134 Florence, Italy; (F.M.D.M.); (F.M.)
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salvador Allende Street 43, 84081 Salerno, Italy; (L.E.); (C.F.); (S.R.); (G.G.)
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salvador Allende Street 43, 84081 Salerno, Italy; (L.E.); (C.F.); (S.R.); (G.G.)
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salvador Allende Street 43, 84081 Salerno, Italy; (L.E.); (C.F.); (S.R.); (G.G.)
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Hioki H, Watanabe Y, Kataoka A, Kawashima H, Kozuma K. Attention when performing transcatheter valve-in-valve procedures in degenerative INSPIRIS RESILIA valves: a case of malfunction in the expansion zone. ASIAINTERVENTION 2023; 9:168-169. [PMID: 37736198 PMCID: PMC10507603 DOI: 10.4244/aij-d-22-00079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/27/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Hirofumi Hioki
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan
| | - Akihisa Kataoka
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan
| | - Hideyuki Kawashima
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan
| | - Ken Kozuma
- Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan
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Nuis RJ, van Belle E, Teles R, Blackman D, Veulemans V, Santos IA, Pilgrim T, Tarantini G, Saia F, Iakovou I, Mascherbauer J, Vincent F, Geleijnse M, Sathananthan J, Wood D, Makkar R, Van Mieghem NM. BAlloon expandable vs. SElf expanding transcatheter vaLve for degenerated bioprosthesIs: design and rationale of the BASELINE trial. Am Heart J 2023; 256:139-147. [PMID: 36410441 DOI: 10.1016/j.ahj.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Surgical aortic valve bioprostheses may degenerate over time and require redo intervention. Transcatheter aortic valve replacement (TAVR) is a less invasive alternative to redo surgery. The BAlloon Expandable vs. SElf Expanding Transcatheter VaLve for Degenerated BioprosthesIs (BASELINE) trial was designed to compare the performance of the balloon-expandable SAPIEN-3 Ultra and the self-expanding EVOLUT PRO+ valve systems in symptomatic patients with a failing surgical bioprosthesis. METHODS The BASELINE trial is an investigator-initiated, non-funded, prospective, randomized, open-label, superiority trial enrolling a total of 440 patients in up to 50 sites in 12 countries in Europe and North-America. The primary endpoint is device success at 30-days defined by the Valve Academic Research Consortium-3 Criteria as the composite of technical success, freedom from mortality, freedom for surgery or intervention related to the device or to a major vascular or access-related or cardiac structural complication with an intended performance of the valve (mean gradient <20 mmHg and less than moderate aortic regurgitation). The co-primary endpoint at 1 year is defined as the composite of all-cause death, disabling stroke, rehospitalization for heart failure or valve related problems. Independent Core Laboratories will conduct uniform analyses of echocardiography (pre-, post-, 1-year post-procedure), multi-sliced computed tomography (pre-, and if available post-procedure) and cine-fluoroscopy studies. CONCLUSIONS The BASELINE trial is a head-to-head comparative trial investigating the 2 most used contemporary transcatheter heart valves for the treatment of a failing surgical aortic bioprosthesis. (ClinicalTrials.gov number NCT04843072).
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Affiliation(s)
- Rutger-Jan Nuis
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Eric van Belle
- Department of Cardiology, Institut Cœur Poumon, Lille, France
| | - Rui Teles
- Hospital de Santa Cruz, CHLO; Nova Medical School, Lisbon, Portugal
| | - Daniel Blackman
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kindom
| | - Verena Veulemans
- Division of Cardiology, Heinrich Heine University Medical Center Dusseldorf, Dusseldorf, Germany
| | - Ignacio Amat Santos
- Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Science and Public Health, University of Padova, Padua, Italy
| | - Francesco Saia
- U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ioannis Iakovou
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Julia Mascherbauer
- Department of Cardiology, University Hospital St. Polten, Sankt Pölten, Austria
| | - Flavien Vincent
- Department of Cardiology, Institut Cœur Poumon, Lille, France
| | - Marcel Geleijnse
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Janarthanan Sathananthan
- Centre for Cardiovascular and Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
| | - David Wood
- Centre for Cardiovascular and Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
| | - Raj Makkar
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands.
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6554163. [DOI: 10.1093/ejcts/ezac158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/14/2022] Open
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Distance between valvular leaflet and coronary ostium predicting risk of coronary obstruction during TAVR. IJC HEART & VASCULATURE 2021; 37:100917. [PMID: 34917750 PMCID: PMC8645442 DOI: 10.1016/j.ijcha.2021.100917] [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: 07/13/2021] [Revised: 11/01/2021] [Accepted: 11/07/2021] [Indexed: 11/22/2022]
Abstract
Background The aim of this study was to evaluate the role of the distance between the aortic valve in projected position to the coronary ostium to determine risk of coronary artery obstruction after transcatheter aortic valve replacement (TAVR). Methods An Expected Leaflet-to-ostium Distance (ELOD) was obtained on pre-TAVR planning computed tomography by subtracting leaflet thickness and the distances from the center to the annular rim at annulus level and from the center to the coronary ostium at mid-ostial level. Variables were compared between patients with and without coronary obstruction and the level of association between variables was assessed using log odds ratio (OR). Results A total of 177 patients with 353 coronary arteries was analyzed. Mean annulus diameters (22.8 ± 2.8 mm and 23.4 ± 1.0 mm, p > 0.05) and mean sinus of Valsalva (SOV) diameters (31.2 ± 3.6 mm and 31.9 ± 3.6 mm, p > 0.05) were similar between patients with lower and higher coronary heights, respectively. There were three coronary obstruction cases. ELOD ≤ 2 mm in combination with leaflet length longer than mid-ostial height allowed for discrimination of cases with and without coronary obstruction. There was a significant association between coronary obstruction event and ELOD ≤ 2 mm (log OR = 6.180, p < 0.001). Conclusions Our study showed that a combination of ELOD < 2 mm and a longer leaflet length than mid-ostial height may be associated with increased risk for coronary obstruction during TAVR.
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Key Words
- CT, computed tomography
- Coronary artery
- Distance
- ELOD, Expected Leaflet-to-ostium Distance
- Height
- Obstruction
- PCI, percutaneous coronary intervention
- SAVR, surgical aortic valve replacement
- SHV, surgical heart valve
- SOV, sinus of Valsalva
- STS PROM, society of thoracic surgeons predicted risk of mortality
- TAVR
- TAVR, transcatheter aortic valve replacement
- TEE, transesophgeal echocardiography
- THV, transcatheter heart valve
- ViV, valve-in-valve
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Simultaneous valve-in-valve procedure and life-saving coronary angioplasty in a patient with low coronary artery ostia. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:234-235. [PMID: 34400932 PMCID: PMC8356842 DOI: 10.5114/aic.2021.107511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/08/2021] [Indexed: 11/23/2022] Open
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Ciardetti N, Ciatti F, Nardi G, Di Muro FM, Demola P, Sottili E, Stolcova M, Ristalli F, Mattesini A, Meucci F, Di Mario C. Advancements in Transcatheter Aortic Valve Implantation: A Focused Update. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:711. [PMID: 34356992 PMCID: PMC8306774 DOI: 10.3390/medicina57070711] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 01/07/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) has become the leading technique for aortic valve replacement in symptomatic patients with severe aortic stenosis with conventional surgical aortic valve replacement (SAVR) now limited to patients younger than 65-75 years due to a combination of unsuitable anatomies (calcified raphae in bicuspid valves, coexistent aneurysm of the ascending aorta) and concerns on the absence of long-term data on TAVI durability. This incredible rise is linked to technological evolutions combined with increased operator experience, which led to procedural refinements and, accordingly, to better outcomes. The article describes the main and newest technical improvements, allowing an extension of the indications (valve-in-valve procedures, intravascular lithotripsy for severely calcified iliac vessels), and a reduction of complications (stroke, pacemaker implantation, aortic regurgitation).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Clinica Medica, Room 124, Careggi University Hospital, Largo Brambilla 3, 50139 Florence, Italy; (N.C.); (F.C.); (G.N.); (F.M.D.M.); (P.D.); (E.S.); (M.S.); (F.R.); (A.M.); (F.M.)
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Malvindi PG, Luthra S, Olevano C, Salem H, Kowalewski M, Ohri S. Aortic valve replacement with biological prosthesis in patients aged 50-69 years. Eur J Cardiothorac Surg 2021; 59:1077-1086. [PMID: 33966072 DOI: 10.1093/ejcts/ezaa429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/01/2020] [Accepted: 10/07/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES There is no consensus regarding the use of biological or mechanical prostheses in patients 50-69 years of age. Previous studies have reported a survival advantage with mechanical valves. Our goal was to compare the long-term survival of patients in the intermediate age groups of 50-59 and 60-69 years receiving mechanical or biological aortic valve prostheses. METHODS We conducted a retrospective analysis of patients in the age groups 50-59 years (n = 329) and 60-69 years (n = 648) who had a first-time isolated aortic valve replacement between 2000 and 2019. Kaplan-Meier and competing risk analyses were performed to compare survival, incidence of aortic valve reoperation, haemorrhagic complications and thromboembolic events for mechanical versus biological prostheses. RESULTS Patients aged 50-59 years with a biological prosthesis had a higher probability of aortic valve reintervention (26.3%, biological vs 2.6% mechanical; P < 0.001 at 15 years). The incidence of haemorrhagic complications or thromboembolic events was similar in the 2 groups. Patients aged 60-69 years with a mechanical prosthesis had a higher risk of haemorrhagic complications (6.9%, biological vs 16.2%, mechanical; P = 0.001 at 15 years). Biological prostheses had a higher overall probability of reintervention for valve dysfunction (20.9%, biological vs 4.8%, mechanical; P = 0.024). In both age groups, there was no difference in long-term survival between patients receiving a biological or a mechanical prosthesis. CONCLUSIONS There was no difference in long-term survival between mechanical and biological prostheses for both age groups. Mechanical prostheses had a higher risk of bleeding in the 60-69-year group whereas biological valves had higher overall reintervention probability without an impact on long-term survival. It may be safe to use biological valves based on lifestyle choices for patients in the 50-69-year age group.
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Affiliation(s)
| | - Suvitesh Luthra
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
| | - Carlo Olevano
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
| | - Hamdy Salem
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
| | - Mariusz Kowalewski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland.,Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Sunil Ohri
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
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Feasibility and effectiveness of transcatheter aortic valve implantation in adults with congenital heart disease. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Belhaj Soulami R, Castro M, Haigron P, Verhoye JP. Computer-assisted valve in valve in a deteriorated Mosaic valve using a library of bioprostheses. Catheter Cardiovasc Interv 2021; 97:E893-E896. [PMID: 33211370 DOI: 10.1002/ccd.29395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/21/2020] [Accepted: 11/08/2020] [Indexed: 11/08/2022]
Abstract
Valve-in-valve (ViV) procedures have emerged from an off-label procedure to a safe and efficient alternative to redo aortic valve replacement in the treatment of symptomatic structural valve deterioration (SVD). During ViV procedures, optimal placement of the transcatheter heart valve (THV) inside the degenerated bioprosthesis is of paramount importance regarding complications such as device embolization, coronary obstruction, periprosthetic regurgitation, residual gradients, and mitral valve injury, but also for the attainment of optimal hemodynamics. In the case of the Mosaic (Medtronic, Minneapolis, MN) valve, the limited radiopaque landmarks represent a challenge to a reproducible, optimal implantation. Such implantation may require multiple contrast injections and transesophageal echocardiogram (TEE) guidance. We herein describe a computer-assisted ViV procedure inside a deteriorated Mosaic valve, achieving reproducible optimal placement using a preacquired library of bioprostheses 3D models. Our approach suggests an evolving paradigm in ViV procedures, from safe and efficient toward optimal therapy for symptomatic SVD.
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Affiliation(s)
- Reda Belhaj Soulami
- Department of thoracic and cardiovascular surgery, Pontchaillou University Hospital, Rennes, France.,Rennes 1 University, LTSI, Rennes, France
| | | | | | - Jean-Philippe Verhoye
- Department of thoracic and cardiovascular surgery, Pontchaillou University Hospital, Rennes, France.,Rennes 1 University, LTSI, Rennes, France
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Saad M, Seoudy H, Frank D. Challenging Anatomies for TAVR-Bicuspid and Beyond. Front Cardiovasc Med 2021; 8:654554. [PMID: 33928138 PMCID: PMC8076502 DOI: 10.3389/fcvm.2021.654554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022] Open
Abstract
Transcatheter aortic valve replacement has emerged as the standard treatment for the majority of patients with symptomatic aortic stenosis. As transcatheter aortic valve replacement expands to patients across all risk groups, optimal patient selection strategies and device implantation techniques become increasingly important. A significant number of patients referred for transcatheter aortic valve replacement present with challenging anatomies and clinical indications that had been historically considered a contraindication for transcatheter aortic valve replacement. This article aims to highlight and discuss some of the potential obstacles that are encountered in clinical practice with a particular emphasis on bicuspid aortic valve disease.
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Affiliation(s)
- Mohammed Saad
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
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Yaakobovich H, Plitman Mayo R, Zaretsky U, Finkelstein A, Weiss D, Marom G. The effect of clinically recommended Evolut sizes on anchorage forces after BASILICA. J Biomech 2021; 118:110303. [PMID: 33601185 DOI: 10.1016/j.jbiomech.2021.110303] [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: 12/30/2020] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
Coronary artery obstruction (CAO), a fatal complication of transcatheter aortic valve replacement (TAVR), is commonly found after Valve-in-Valve implantation inside a degenerated bioprosthetic valve. Leaflet laceration (BASILICA technique) has been proposed to prevent CAO and to potentially reduce the risk of leaflet thrombosis. We have previously demonstrated that this technique can reduce the anchorage forces of the TAVR device, which may lead to future complications. In this short communication, we hypothesize that the anchorage force reduction can be minimized by implanting a TAVR with a larger diameter, if two sizes are clinically recommended. We evaluated this hypothesis by employing finite element models of the deployments of the Evolut 26 and 29 mm inside a 27 mm Mitroflow valve, with and without leaflet lacerations. The results show that a laceration substantially decreases the contact area between the Evolut stent and the Mitroflow valve. The larger Evolut has a larger contact area and stronger anchorage forces. Additionally, the anchorage forces are less sensitive to additional lacerations in the larger Evolut (29 case). The results suggest that a larger self-expending device can ensure stronger anchorage and can lower the risk of possible migration, when TAVR is performed in a lacerated bioprosthesis.
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Affiliation(s)
- Halit Yaakobovich
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | - Uri Zaretsky
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | - Dar Weiss
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel; Department of Biomedical Engineering, Yale University, CT, USA
| | - Gil Marom
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel.
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13
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Shah VN, Buckley M, Orlov OI, Imperato NS, Sicouri S, Goldman SM, Plestis KA. Transcatheter and ministernotomy aortic valve replacement after bioprosthetic valve failure. J Card Surg 2020; 36:493-500. [PMID: 33283359 DOI: 10.1111/jocs.15225] [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: 09/05/2020] [Revised: 10/27/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transcatheter valve-in-valve implantation (TViV) and minimally invasive reoperative aortic valve replacement (MIrAVR) have rapidly increased as alternatives to conventional reoperative surgical AVR. This study reports a single-center experience of patients undergoing TViV and MIrAVR after bioprosthetic valve failure. METHODS In this retrospective review between March 2009 and October 2018, 68 patients without reoperative full sternotomies, concomitant procedures, active endocarditis, and prior homografts or coronary artery bypass grafting underwent isolated AVR for degenerated aortic bioprostheses. Society of Thoracic Surgeons (STS) risk scores and age are reported as median (interquartile range [IQR]) and length of stay is reported as mean (standard deviation [SD]) due to their characteristics of the distribution. RESULTS Forty-one (60.3%) patients underwent TViV, and 27 (39.7%) patients underwent MIrAVR. Median [IQR] STS risk scores were 5.7 [4.0-7.8] and 2.0 [1.5-3.4] for TViV and MIrAVR, respectively (p ≤ .001). The median [IQR] age for TViV patients was higher (78 [71-84] vs. 66 [53-72] years, p ≤ 0.001). More permanent pacemakers were implanted (22.2% vs. 9.8%) following MIrAVR. The MIrAVR group had a higher rate of atrial fibrillation (18.5% vs. 9.8%, p = .466). Average (SD) length of stay was less in TViV (5.3 days, SD: 3.4 vs. 8.6 days, SD: 7.4, p = .001). Survival at 1 year was not significantly different for TViV and MIrAVR (94.9% [95% confidence interval [CI]: 81.0%, 98.7%] and 86.9% [95% CI: 64.0%, 95.7%], respectively [p = .969]). CONCLUSIONS Despite being at higher-risk, patients undergoing TViV had reduced rates of permanent pacemaker implantations and atrial fibrillation, and a shorter hospital stay as compared to MIrAVR. Survival at 1-year was similar between the two groups.
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Affiliation(s)
- Vishal N Shah
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA.,Structural Heart Disease Program, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA
| | - Meghan Buckley
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Oleg I Orlov
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA
| | | | - Serge Sicouri
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Scott M Goldman
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA.,Structural Heart Disease Program, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA
| | - Konstadinos A Plestis
- Department of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Yashima F, Yokoyama Y, Takagi H, Briasoulis A, Kuno T. Clinical outcomes of transcatheter aortic valve implantation in failed bioprosthetic surgical valves vs. native aortic stenosis: insights from a meta-analysis. Cardiovasc Interv Ther 2020; 37:182-190. [PMID: 33206349 DOI: 10.1007/s12928-020-00732-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
There is no meta-analysis comparing clinical outcomes between valve-in-valve transcatheter aortic valve implantation for failed surgical bioprosthetic valves (ViV-TAVI) and native valve TAVI for aortic stenosis (NV-TAVI). We aimed to investigate clinical outcomes between ViV-TAVI and NV-TAVI using a meta-analysis. EMBASE and MEDLINE were searched through April 2020 to investigate the comparative outcomes between ViV-TAVI and NV-TAVI. The main outcomes were short-term (30-day/in-hospital) mortality, pacemaker implantation (PMI), life threatening and/or major bleeding, stroke, and coronary obstruction, and long-term (1-year) mortality and stroke. Our search identified 5 observational studies enrolling a total of 8428 patients (1442 patients with ViV-TAVI and 6986 with NV-TAVI). ViV-TAVI was associated with significantly lower rates of short-term mortality, PMI, and life threatening and/or major bleeding, compared with NV-TAVI (relative risk [RR] [95% CI] 0.54 [0.34-0.84], P = 0.007; 0.25 [0.19-0.35], P < 0.0001; 0.64 [0.46-0.89], P = 0.008, respectively). There were no significant differences in rates of short-term stroke and coronary obstruction between ViV-TAVI and NV-TAVI (RR [95% CI] 0.59 [0.35-1.01], P = 0.06; 1.86 [0.78-4.41], P = 0.16, respectively). ViV-TAVI was also associated with a significantly lower rate of 1-year mortality compared with NV-TAVI (RR [95% CI] 0.64 [0.51-0.81], P = 0.0002), whereas there was no significant difference in long-term stroke (RR [95% CI] 0.71 [0.45-1.12], P = 0.51). ViV-TAVI was associated with significantly lower rates of short-term mortality, PMI, and life threatening and/or major bleeding, and long-term mortality, without increased risks of stroke and coronary obstruction, compared with NV-TAVI.
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Affiliation(s)
- Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Yujiro Yokoyama
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa, USA
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue, 16th street, New York, NY, 10003, USA.
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15
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Overtchouk P, Piazza N, Granada JF, Modine T. Predictors of adverse outcomes after transcatheter mitral valve replacement. Expert Rev Cardiovasc Ther 2019; 17:625-632. [PMID: 31403364 DOI: 10.1080/14779072.2019.1653186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Transcatheter mitral valve replacement (TMVR) is still a recent technology with numerous unknowns but also great promises. The risk of complications reported in observational studies have limited its adoption by interventional cardiology and surgical communities. Areas covered: Some of the major setbacks of TMVR are complications related to the devices and those related to the pathway. Device-related complications include left ventricle outflow tract (LVOT) obstruction, transcatheter heart valve (THV) dislocation or embolization, thrombosis, and stroke. The transapical approach currently remains the main pathway for TMVR but is associated with high risk of major bleeding and residual apical myocardial scarring. Complication prediction and prevention seem possible. Device-related complication prediction is based on pre-operative imaging including multi-slice computed tomography with 3-dimensional reconstructions and echocardiography which allow LVOT obstruction prediction and appropriate sizing aiming at avoiding dislocation. Industry should aim at the development of transfemoral delivery systems. Nevertheless, several recent feasibility observational studies suggested acceptable safety and efficacy of transcatheter mitral valve replacement. Expert opinion: TMVR complications and transapical delivery are some of the main setbacks which need to be addressed for TMVR to be adopted for broad clinical use.
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Affiliation(s)
- Pavel Overtchouk
- Department of Cardiology, University Hospital of Bern , Bern , Switzerland.,Interventional cardiology, McGill University Health Centre , Montréal , Canada
| | - Nicolo Piazza
- Interventional cardiology, McGill University Health Centre , Montréal , Canada
| | - Juan F Granada
- Cardiovascular Research Foundation, Columbia University Medical Center, CRF Skirball Center for Innovation , New York , NY , USA
| | - Thomas Modine
- Cardiology and Cardiovascular Surgery Department, Heart Valve Center, Institut Cœur Poumon CHU de Lille , Lille , France.,Cardiovascular Surgery, Jioa Tong university , Shanghai , China
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16
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Koni E, Trianni G, Ravani M, Gasbarri T, Al Jabri A, Chiappino D, Berti S. Bailout Balloon Predilatation and Buddy Wire Technique for Crossing a Degenerated Sutureless Perceval Bioprosthesis with SAPIEN 3 Ultra Device in a Transcatheter Valve-in-Valve Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:75-78. [PMID: 31279537 DOI: 10.1016/j.carrev.2019.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/25/2019] [Accepted: 06/25/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Endrin Koni
- Fondazione C.N.R. G. Monasterio, Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, MS, Italy; Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100 Sassari, SS, Italy.
| | - Giuseppe Trianni
- Fondazione C.N.R. G. Monasterio, Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, MS, Italy.
| | - Marcello Ravani
- Fondazione C.N.R. G. Monasterio, Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, MS, Italy.
| | - Tomaso Gasbarri
- Fondazione C.N.R. G. Monasterio, Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, MS, Italy.
| | - Anees Al Jabri
- Fondazione C.N.R. G. Monasterio, Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, MS, Italy.
| | - Dante Chiappino
- Fondazione C.N.R. G. Monasterio, Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, MS, Italy.
| | - Sergio Berti
- Fondazione C.N.R. G. Monasterio, Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, MS, Italy.
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17
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Savoj J, Iftikhar S, Burstein S, Hu P. Transcatheter Double Valve-in-Valve Replacement of Aortic and Mitral Bioprosthetic Valves. Cardiol Res 2019; 10:193-198. [PMID: 31236183 PMCID: PMC6575110 DOI: 10.14740/cr863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/23/2019] [Indexed: 12/01/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is an evolving method which has become the treatment of choice in high-risk patients with severe aortic stenosis. Unlike TAVR, the experience with transcatheter mitral valve replacement (TMVR) remains at an early stage because of challenges of valve development and possible complications such as valve displacement and subsequent left ventricular outlet tract (LVOT) obstruction. Here we report a case of transcatheter double valve-in-valve replacement (TDVIVR) in a patient with severe mitral and aortic bioprosthetic valve stenosis, followed by an extensive literature review of the latest techniques and challenges in this field.
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Affiliation(s)
- Javad Savoj
- Department of Internal Medicine, UC Riverside School of Medicine/Riverside Community Hospital, Riverside, CA 92501, USA
| | - Syed Iftikhar
- Department of Internal Medicine, UC Riverside School of Medicine/Riverside Community Hospital, Riverside, CA 92501, USA
| | - Steven Burstein
- Department of Cardiology, Good Samaritan Hospital/Harbor-UCLA, Los Angeles, CA 90017, USA
| | - Patrick Hu
- Department of Internal Medicine, UC Riverside School of Medicine/Riverside Community Hospital, Riverside, CA 92501, USA.,Department of Cardiology, Riverside Medical Clinic, Riverside, CA 92501, USA
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18
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Kossar AP, Borger M, George I. Direct access valve-in-valve implantation for management of complex valvulopathy. Catheter Cardiovasc Interv 2019; 93:1385-1388. [PMID: 30963696 PMCID: PMC6557424 DOI: 10.1002/ccd.28179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/01/2019] [Accepted: 02/18/2019] [Indexed: 11/07/2022]
Abstract
The management of bioprosthetic structural valve degeneration requires complex surgical or transcatheter re-intervention for which many high-risk patients are not considered candidates. Here, we describe a technique for a direct surgical access valve-in-valve implantation in patients with complex bioprosthetic valvulopathy for whom standard surgical valve replacement and percutaneous interventions were high-risk and contraindicated, respectively.
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Affiliation(s)
- Alexander P Kossar
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York
| | - Michael Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Isaac George
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York
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19
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Belhaj Soulami R, Castro M, Haigron P, Verhoye JP. Structural valve deterioration does not alter tissue valves' radiopaque landmarks: Implications for valve-in-valve therapy. Med Hypotheses 2019; 127:49-56. [PMID: 31088647 DOI: 10.1016/j.mehy.2019.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/20/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Valve-in-valve is established as a safe and efficient alternative to redo surgery in the treatment of structural valve deterioration (SVD). In vitro models rely on the radiopaque landmarks of undeteriorated tissue valves to establish the optimal implantation level of the transcatheter heart valves inside the deteriorated valves. In computed assisted procedures, the radiopaque landmarks of the deteriorated valves may be used to guide valve implantation through image fusion. The purpose of this study is to determine whether SVD alters the radiopaque landmarks of stented tissue valves. METHODS Our approach was based on the computation of relevant anatomical measurements from CT images. Radiopaque landmarks of degenerated bioprostheses and the corresponding undeteriorated valves were extracted to create surface meshes and cloud points using grey-level thresholding. 3D registration using an iterative closest point algorithm was used to align the corresponding cloud points, while the modified Hausdorff Distance was applied to determine the differences between them. RESULTS The proposed evaluation was performed on 19 degenerated tissue valves. 15 valves were scanned from patients evaluated for valve-in-valve procedures, and 4 bioprostheses were scanned after surgical extraction during redo aortic valve replacement. All the degenerated valves were compared to the corresponding undeteriorated models. Overall, the mean difference between degenerated and undeteriorated valves was 0.33 ± 0.12 mm. The maximum observed registration error was 0.66 mm. CONCLUSIONS Our study demonstrates no significant difference between the radiopaque landmarks of deteriorated and undeteriorated bioprostheses after the occurrence of SVD. Our findings suggest therefore that SVD does not alter radiopaque landmarks of stented tissue valves. These results validate in-vitro studies of optimal transcatheter heart valves implantation inside deteriorated tissue valves based on their radiopaque landmarks, and allow the use of non-deteriorated valves' imaging features in computer assisted valve-in-valve procedures.
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Affiliation(s)
- Réda Belhaj Soulami
- INSERM, UMR 1099, Rennes F-35000, France; Université de Rennes 1, LTSI, Rennes F-35000, France; Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France.
| | - Miguel Castro
- INSERM, UMR 1099, Rennes F-35000, France; Université de Rennes 1, LTSI, Rennes F-35000, France
| | - Pascal Haigron
- INSERM, UMR 1099, Rennes F-35000, France; Université de Rennes 1, LTSI, Rennes F-35000, France
| | - Jean-Philippe Verhoye
- INSERM, UMR 1099, Rennes F-35000, France; Université de Rennes 1, LTSI, Rennes F-35000, France; Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
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20
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Fetahovic T, Hayman S, Cox S, Cole C, Rafter T, Camuglia A. The Prophylactic Chimney Snorkel Technique for the Prevention of Acute Coronary Occlusion in High Risk for Coronary Obstruction Transcatheter Aortic Valve Replacement/Implantation Cases. Heart Lung Circ 2019; 28:e126-e130. [PMID: 31113727 DOI: 10.1016/j.hlc.2019.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/09/2019] [Accepted: 04/11/2019] [Indexed: 11/19/2022]
Abstract
Coronary occlusion (immediate or delayed) is an uncommon but potentially devastating complication of transcatheter aortic valve replacement/implantation (TAVR/TAVI). Several patient-related, anatomical, device and procedural risk factors can be assessed to risk-stratify patients and assist in procedural planning. In patients at high risk for coronary occlusion, coronary protection measures should be employed. In the highest risk patients, consideration should be given to prophylactic techniques to prevent coronary occlusion. This how-to-do-it report provides a framework for risk assessment for coronary occlusion followed by a step-wise description of the emerging chimney snorkel coronary stenting technique as a predictable procedural approach for the management of this potentially challenging clinical scenario.
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Affiliation(s)
- Taufik Fetahovic
- Department of Cardiology, University of Queensland, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Sam Hayman
- GenesisCare, The Wesley Hospital, Brisbane, Qld, Australia; Department of Cardiology, University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - Stephen Cox
- Department of Cardiology, University of Queensland, Princess Alexandra Hospital, Brisbane, Qld, Australia; GenesisCare, The Wesley Hospital, Brisbane, Qld, Australia
| | - Chris Cole
- Department of Cardiology, University of Queensland, Princess Alexandra Hospital, Brisbane, Qld, Australia; GenesisCare, The Wesley Hospital, Brisbane, Qld, Australia
| | - Tony Rafter
- Department of Cardiology, University of Queensland, Princess Alexandra Hospital, Brisbane, Qld, Australia; GenesisCare, The Wesley Hospital, Brisbane, Qld, Australia
| | - Anthony Camuglia
- Department of Cardiology, University of Queensland, Princess Alexandra Hospital, Brisbane, Qld, Australia; GenesisCare, The Wesley Hospital, Brisbane, Qld, Australia.
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21
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Stankowski T, Aboul-Hassan SS, Seifi-Zinab F, Herwig V, Kubikova M, Harnath A, Fritzsche D, Perek B. Severe structural deterioration of small aortic bioprostheses treated with valve-in-valve transcatheter aortic valve implantation. J Card Surg 2019; 34:7-13. [PMID: 30625244 DOI: 10.1111/jocs.13976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate outcomes of valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) in patients with degenerated small bioprostheses. METHODS Outcomes of consecutive 27 high-risk patients (logistic EuroSCORE 35.5 ± 18.5%) with a mean age of 81.0 ± 5.9 years who underwent VIV-TAVI for degenerated small bioprostheses (19 mm-11.1%; 20 mm-11.1%; 21 mm-77.8%) were analyzed. Medtronic CoreValve (n = 11) or CoreValve Evolut-R prostheses (n = 16) were implanted. Follow-up was 3.2 ± 2.0 years. RESULTS Early mortality was 11.1%. One patient died intraoperatively due to left ventricle perforation, two others during the in-hospital period as a result of sudden cardiac death and pulmonary embolism. VIV-TAVI was completed in 26 cases (96.3%-success rate). Two patients required pacemaker implantation. Acute kidney injury occurred in two other patients. At discharge, mean transvalvular gradient was 19.2 ± 9.5 mmHg and in 25.9% of patients mean gradient exceeded 20 mmHg. Overall mortality was 25.9% and mortality from cardiac or unknown causes at 18.5%. Ninety percent of survivors were in New York Heart Association (NYHA) class I or II. CONCLUSIONS Transfemoral VIV-TAVI in patients with small, degenerated bioprostheses appears to be a promising alternative to surgery. Although the vast majority of patients have significant improvement in their NYHA class, the rate of persistent, residual gradients is relatively high and will need to be followed closely with serial echocardiograms.
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Affiliation(s)
- Tomasz Stankowski
- Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | | | | | - Volker Herwig
- Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Miroslava Kubikova
- Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Axel Harnath
- Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Dirk Fritzsche
- Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
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22
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Schaefer A, Deuschl F, Conradi L, Schäfer U. Valve-in-valve-in-valve: Balloon expandable transcatheter heart valve in failing self-expandable transcatheter heart valve in deteriorated surgical bioprosthesis. Catheter Cardiovasc Interv 2018; 92:E481-E485. [PMID: 30196560 DOI: 10.1002/ccd.27797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 11/11/2022]
Abstract
Valve-in-valve (ViV) procedures for failing bioprostheses carry a certain risk for device malfunction. We herein report a case of a failing Evolut R in a deteriorated Mitroflow, treated with a Sapien 3. An 81 year old female patient received surgical aortic valve replacement and was treated by ViV due to deterioration. Three years later, echocardiography revealed a pressure gradient of peak/mean 105/63 mmHg. Subsequently, a second ViV procedure with initial intentional rupture of the bioprosthetic stent was performed. Immediate stent recoil of the Evolut R prompted implantation of a Sapien 3. In 30-day follow-up, mean pressure gradient of 30 mmHg and nearly complete symptom relief was documented. Fracture of a surgical bioprosthetic stent is feasible in a ViV configuration. Supra-annular placement of a balloon-expandable THV as ViV-in-valve is feasible with suboptimal hemodynamic results in this case. Risk of re-do surgery should be weighted against anticipated hemodynamic and clinical results.
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Affiliation(s)
- Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistraße 52, D-20246 Hamburg, Germany
| | - Florian Deuschl
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistraße 52, D-20246 Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistraße 52, D-20246 Hamburg, Germany
| | - Ulrich Schäfer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistraße 52, D-20246 Hamburg, Germany
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