Series of transcatheter valve‐in‐valve implantations in high‐risk patients with degenerated bioprostheses in aortic and mitral position
- 30 April 2010
- journal article
- valvular and-structural-heart-diseases
- Published by Wiley in Catheterization and Cardiovascular Interventions
- Vol. 76 (4), 608-615
- https://doi.org/10.1002/ccd.22618
Abstract
Objectives: We report our experience with transcatheter valve‐in‐valve implantations in patients with degenerated bioprostheses in aortic and mitral position. Background: Xenograft degeneration is a potential problem after biological valve replacement. Reoperation remains the gold standard with very good short‐ and long‐term results. In selected patients not suitable for surgery however, interventional techniques for valve implantation and repair may be valuable alternative treatment options with regard to the good results of transcatheter valve implantation for native aortic valve stenosis. Methods: Five patients presented with significant xenograft degeneration 15.4 ± 5.2 years after aortic (n = 4) and mitral (n = 1) valve replacement. Mean patient age was 82.0 ± 6.5 years and predicted operative mortality was 55.8% ± 18.9% (logistic EuroSCORE). Transcatheter valve‐in‐valve implantation was performed successfully through a transapical access in all patients. A 23‐mm Edwards Sapien valve was deployed into the degenerated valve prosthesis. Results: Mean transvalvular gradients were reduced from 31.2 ± 17.4 to 19.0 ± 12.4 mm Hg in aortic and from 9 to 3 mm Hg in mitral position without significant regurgitation in any of these patients. Two patients died within 30 days due to low cardiac output and acute hemorrhage, respectively, one of whom presented with a EuroSCORE of 88.9%. Conclusions: With growing need for reoperative valve replacement in elderly patients with disproportional operative risks, transcatheter valve‐in‐valve implantation in aortic and mitral position offers an alternative treatment option. Although valve function after transcatheter implantation was good in all patients, two high risk patients died in the postoperative period due to their significant comorbidities, underscoring the bail‐out character of this procedure.Keywords
This publication has 22 references indexed in Scilit:
- Trans-apical aortic valve implantation: univariate and multivariate analyses of the early results from the SOURCE registry☆☆☆European Journal of Cardio-Thoracic Surgery, 2010
- Transapical off-pump aortic valve-in-a-valve implantation in two elderly patients with a degenerated porcine bioprosthesisEuropean Journal of Cardio-Thoracic Surgery, 2010
- First trans‐axillary implantation of Edwards Sapien valve to treat an incompetent aortic bioprosthesisCatheterization and Cardiovascular Interventions, 2010
- Redo Valvular Surgery in Elderly PatientsThe Annals of Thoracic Surgery, 2009
- Valve-in-a-Valve Implantation: A Word of CautionThe Annals of Thoracic Surgery, 2009
- Transcatheter valve in valve implants for failed prosthetic valvesCatheterization and Cardiovascular Interventions, 2007
- Very Long-Term Survival Implications of Heart Valve Replacement With Tissue Versus Mechanical Prostheses in Adults <60 Years of AgeCirculation, 2007
- Midterm Results and Quality of Life after Minimally Invasive vs. Conventional Aortic Valve ReplacementThe Thoracic and Cardiovascular Surgeon, 2002
- The effect of aortic valve replacement on survival.Cell Metabolism, 1982
- Aortic StenosisCirculation, 1968