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Linke A, Woitek F, Merx MW, Schiefer C, Möbius-Winkler S, Holzhey D, Rastan A, Ender J, Walther T, Kelm M, Mohr FW, Schuler G. Valve-in-Valve Implantation of Medtronic CoreValve Prosthesis in Patients with Failing Bioprosthetic Aortic Valves. Circ Cardiovasc Interv 2012; 5:689-97. [DOI: 10.1161/circinterventions.112.972331] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Transcatheter aortic valve implantation (TAVI) using the Medtronic CoreValve (MCV) system might represent an alternative to conventional redo surgery in older high-risk patients with a failing aortic valve bioprosthesis.
Methods and Results—
Symptomatic patients with failing aortic valve bioprosthesis, aged ≥65 years with a logistic EuroSCORE ≥10 % were considered for treatment. Local anesthesia was used to retrogradely implant the MCV system into the failing bioprosthetic valve. Clinical events were recorded and a transthoracic echocardiography was performed to evaluate the impact of MCV on hemodynamics after transcatheter aortic valve implantation. A total of 27 patients (aged 74.8±8 years, logistic EuroSCORE of 31±17%) were treated. In those with AS and AS and AR (n=25), the mean gradient declined from 42±16 mm Hg before to 18±8 mm Hg after MCV implantation (
P
<0.001), in those with AR the level declined by 2. There was no intraprocedural death and no procedural myocardial infarction. On the basis of the definitions of the Valvular Academic Research Consortium, the rate of major stroke was 7.4 %, of life-threatening bleeding 7.4%, of kidney failure stage III 7.4%, and of major access site complication 11.1 %, respectively. Within 30 days after the procedure, 2 patients died; 1 from stroke and 1 from cardiac failure (30-day mortality: 7.4%).
Conclusions—
These results suggest that transfemoral MCV implantation into a wide range of degenerated aortic bioprosthetic valves—irrespective of the failure mode—is feasible, safe, and improves hemodynamics in older patients with higher risk for conventional aortic valve redo surgery.
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Affiliation(s)
- Axel Linke
- From the Department of Cardiology (A.L., F.W., C.S., S.M-W, G.S.), Department of Cardiothoracic Surgery (D.H., A.R., F.W.M.), Department of Anesthesiology (J.E.), University of Leipzig–Heart Center, Leipzig, Germany; Department of Pneumology, Angiology and Cardiology, University of Düsseldorf, Düsseldorf, Germany (M.W.M., M.K.); and Kerckhoff-Klinik Bad Nauheim, Department of Cardiac Surgery, Bad Nauheim, Germany (T.W.)
| | - Felix Woitek
- From the Department of Cardiology (A.L., F.W., C.S., S.M-W, G.S.), Department of Cardiothoracic Surgery (D.H., A.R., F.W.M.), Department of Anesthesiology (J.E.), University of Leipzig–Heart Center, Leipzig, Germany; Department of Pneumology, Angiology and Cardiology, University of Düsseldorf, Düsseldorf, Germany (M.W.M., M.K.); and Kerckhoff-Klinik Bad Nauheim, Department of Cardiac Surgery, Bad Nauheim, Germany (T.W.)
| | - Marc W. Merx
- From the Department of Cardiology (A.L., F.W., C.S., S.M-W, G.S.), Department of Cardiothoracic Surgery (D.H., A.R., F.W.M.), Department of Anesthesiology (J.E.), University of Leipzig–Heart Center, Leipzig, Germany; Department of Pneumology, Angiology and Cardiology, University of Düsseldorf, Düsseldorf, Germany (M.W.M., M.K.); and Kerckhoff-Klinik Bad Nauheim, Department of Cardiac Surgery, Bad Nauheim, Germany (T.W.)
| | - Conrad Schiefer
- From the Department of Cardiology (A.L., F.W., C.S., S.M-W, G.S.), Department of Cardiothoracic Surgery (D.H., A.R., F.W.M.), Department of Anesthesiology (J.E.), University of Leipzig–Heart Center, Leipzig, Germany; Department of Pneumology, Angiology and Cardiology, University of Düsseldorf, Düsseldorf, Germany (M.W.M., M.K.); and Kerckhoff-Klinik Bad Nauheim, Department of Cardiac Surgery, Bad Nauheim, Germany (T.W.)
| | - Sven Möbius-Winkler
- From the Department of Cardiology (A.L., F.W., C.S., S.M-W, G.S.), Department of Cardiothoracic Surgery (D.H., A.R., F.W.M.), Department of Anesthesiology (J.E.), University of Leipzig–Heart Center, Leipzig, Germany; Department of Pneumology, Angiology and Cardiology, University of Düsseldorf, Düsseldorf, Germany (M.W.M., M.K.); and Kerckhoff-Klinik Bad Nauheim, Department of Cardiac Surgery, Bad Nauheim, Germany (T.W.)
| | - David Holzhey
- From the Department of Cardiology (A.L., F.W., C.S., S.M-W, G.S.), Department of Cardiothoracic Surgery (D.H., A.R., F.W.M.), Department of Anesthesiology (J.E.), University of Leipzig–Heart Center, Leipzig, Germany; Department of Pneumology, Angiology and Cardiology, University of Düsseldorf, Düsseldorf, Germany (M.W.M., M.K.); and Kerckhoff-Klinik Bad Nauheim, Department of Cardiac Surgery, Bad Nauheim, Germany (T.W.)
| | - Ardawan Rastan
- From the Department of Cardiology (A.L., F.W., C.S., S.M-W, G.S.), Department of Cardiothoracic Surgery (D.H., A.R., F.W.M.), Department of Anesthesiology (J.E.), University of Leipzig–Heart Center, Leipzig, Germany; Department of Pneumology, Angiology and Cardiology, University of Düsseldorf, Düsseldorf, Germany (M.W.M., M.K.); and Kerckhoff-Klinik Bad Nauheim, Department of Cardiac Surgery, Bad Nauheim, Germany (T.W.)
| | - Jörg Ender
- From the Department of Cardiology (A.L., F.W., C.S., S.M-W, G.S.), Department of Cardiothoracic Surgery (D.H., A.R., F.W.M.), Department of Anesthesiology (J.E.), University of Leipzig–Heart Center, Leipzig, Germany; Department of Pneumology, Angiology and Cardiology, University of Düsseldorf, Düsseldorf, Germany (M.W.M., M.K.); and Kerckhoff-Klinik Bad Nauheim, Department of Cardiac Surgery, Bad Nauheim, Germany (T.W.)
| | - Thomas Walther
- From the Department of Cardiology (A.L., F.W., C.S., S.M-W, G.S.), Department of Cardiothoracic Surgery (D.H., A.R., F.W.M.), Department of Anesthesiology (J.E.), University of Leipzig–Heart Center, Leipzig, Germany; Department of Pneumology, Angiology and Cardiology, University of Düsseldorf, Düsseldorf, Germany (M.W.M., M.K.); and Kerckhoff-Klinik Bad Nauheim, Department of Cardiac Surgery, Bad Nauheim, Germany (T.W.)
| | - Malte Kelm
- From the Department of Cardiology (A.L., F.W., C.S., S.M-W, G.S.), Department of Cardiothoracic Surgery (D.H., A.R., F.W.M.), Department of Anesthesiology (J.E.), University of Leipzig–Heart Center, Leipzig, Germany; Department of Pneumology, Angiology and Cardiology, University of Düsseldorf, Düsseldorf, Germany (M.W.M., M.K.); and Kerckhoff-Klinik Bad Nauheim, Department of Cardiac Surgery, Bad Nauheim, Germany (T.W.)
| | - Friedrich W. Mohr
- From the Department of Cardiology (A.L., F.W., C.S., S.M-W, G.S.), Department of Cardiothoracic Surgery (D.H., A.R., F.W.M.), Department of Anesthesiology (J.E.), University of Leipzig–Heart Center, Leipzig, Germany; Department of Pneumology, Angiology and Cardiology, University of Düsseldorf, Düsseldorf, Germany (M.W.M., M.K.); and Kerckhoff-Klinik Bad Nauheim, Department of Cardiac Surgery, Bad Nauheim, Germany (T.W.)
| | - Gerhard Schuler
- From the Department of Cardiology (A.L., F.W., C.S., S.M-W, G.S.), Department of Cardiothoracic Surgery (D.H., A.R., F.W.M.), Department of Anesthesiology (J.E.), University of Leipzig–Heart Center, Leipzig, Germany; Department of Pneumology, Angiology and Cardiology, University of Düsseldorf, Düsseldorf, Germany (M.W.M., M.K.); and Kerckhoff-Klinik Bad Nauheim, Department of Cardiac Surgery, Bad Nauheim, Germany (T.W.)
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Descoutures F, Himbert D, Radu C, Iung B, Cueff C, Messika-Zeitoun D, Ducrocq G, Brochet E, Nataf P, Vahanian A. Transarterial Medtronic CoreValve System Implantation for Degenerated Surgically Implanted Aortic Prostheses. Circ Cardiovasc Interv 2011; 4:488-94. [DOI: 10.1161/circinterventions.111.962589] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
To assess the results of transcatheter aortic valve implantation (TAVI) using the Medtronic CoreValve System (MCS), through the transarterial approach, in high-risk patients with degenerated surgically implanted aortic bioprostheses (SP).
Methods and Results—
Of 241 patients who underwent TAVI, 10 (4%) had a degenerated SP. The approach was percutaneous transfemoral in 9 cases and surgical transaxillary in 1. Patients were age 75±10 years of age. All were in New York Heart Association classes III or IV and at high risk for repeated surgery. Seven patients had stented, 2 stentless, and 1 homograft SP. The failure mode was predominant regurgitation in 7 cases and stenosis (aortic valve area, 0.7±0.2 cm
2
; mean gradient, 58±16 mm Hg) in 3. Based on the echographic measurements, 8 patients received a 26-mm, and 2 a 29-mm-diameter MCS. Procedural success rate was 100%. There was 1 in-hospital death, 1 stroke with moderate sequelae, and 1 pacemaker implantation. There were no other adverse events at 30 days. The mean postimplantation transprosthetic gradient was 13±7 mm Hg; periprosthetic regurgitation was absent or trivial in 9 cases and grade 2 in 1. After a median follow-up of 5 months, there were no additional adverse events. All but 1 of the hospital survivors were in New York Heart Association classes I or II.
Conclusions—
These results suggest that transarterial MCS implantation in degenerated SP is feasible and may lead to hemodynamic and clinical improvement in patients who are poor candidates for repeated surgery, pending confirmation in larger series with longer follow-up.
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Affiliation(s)
- Fleur Descoutures
- From Assistance Publique-Hôpitaux de Paris, the Department of Cardiology (F.D., D.H., B.I., C.C., D.M.-Z., G.D., E.B., A.V.) and the Department of Cardiovascular Surgery (C.R., P.N.), Bichat–Claude Bernard Hospital, Paris, France
| | - Dominique Himbert
- From Assistance Publique-Hôpitaux de Paris, the Department of Cardiology (F.D., D.H., B.I., C.C., D.M.-Z., G.D., E.B., A.V.) and the Department of Cardiovascular Surgery (C.R., P.N.), Bichat–Claude Bernard Hospital, Paris, France
| | - Costin Radu
- From Assistance Publique-Hôpitaux de Paris, the Department of Cardiology (F.D., D.H., B.I., C.C., D.M.-Z., G.D., E.B., A.V.) and the Department of Cardiovascular Surgery (C.R., P.N.), Bichat–Claude Bernard Hospital, Paris, France
| | - Bernard Iung
- From Assistance Publique-Hôpitaux de Paris, the Department of Cardiology (F.D., D.H., B.I., C.C., D.M.-Z., G.D., E.B., A.V.) and the Department of Cardiovascular Surgery (C.R., P.N.), Bichat–Claude Bernard Hospital, Paris, France
| | - Caroline Cueff
- From Assistance Publique-Hôpitaux de Paris, the Department of Cardiology (F.D., D.H., B.I., C.C., D.M.-Z., G.D., E.B., A.V.) and the Department of Cardiovascular Surgery (C.R., P.N.), Bichat–Claude Bernard Hospital, Paris, France
| | - David Messika-Zeitoun
- From Assistance Publique-Hôpitaux de Paris, the Department of Cardiology (F.D., D.H., B.I., C.C., D.M.-Z., G.D., E.B., A.V.) and the Department of Cardiovascular Surgery (C.R., P.N.), Bichat–Claude Bernard Hospital, Paris, France
| | - Gregory Ducrocq
- From Assistance Publique-Hôpitaux de Paris, the Department of Cardiology (F.D., D.H., B.I., C.C., D.M.-Z., G.D., E.B., A.V.) and the Department of Cardiovascular Surgery (C.R., P.N.), Bichat–Claude Bernard Hospital, Paris, France
| | - Eric Brochet
- From Assistance Publique-Hôpitaux de Paris, the Department of Cardiology (F.D., D.H., B.I., C.C., D.M.-Z., G.D., E.B., A.V.) and the Department of Cardiovascular Surgery (C.R., P.N.), Bichat–Claude Bernard Hospital, Paris, France
| | - Patrick Nataf
- From Assistance Publique-Hôpitaux de Paris, the Department of Cardiology (F.D., D.H., B.I., C.C., D.M.-Z., G.D., E.B., A.V.) and the Department of Cardiovascular Surgery (C.R., P.N.), Bichat–Claude Bernard Hospital, Paris, France
| | - Alec Vahanian
- From Assistance Publique-Hôpitaux de Paris, the Department of Cardiology (F.D., D.H., B.I., C.C., D.M.-Z., G.D., E.B., A.V.) and the Department of Cardiovascular Surgery (C.R., P.N.), Bichat–Claude Bernard Hospital, Paris, France
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