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Marin-Cuartas M, de Waha S, Saeed D, Misfeld M, Kiefer P, Borger MA. Considerations for Reoperative Heart Valve Surgery. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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2
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Katz MS, Greason KL, Crestanello JA, Mankad SV, Guerrero ME, Gulati R, Alkhouli M, Michelena HI, Nkomo VT, Rihal CS, Eleid MF. Renal function changes associated with transcatheter aortic valve-in-valve for prosthetic regurgitation compared to stenosis. IJC HEART & VASCULATURE 2022; 39:100999. [PMID: 35310374 PMCID: PMC8927844 DOI: 10.1016/j.ijcha.2022.100999] [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: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 11/28/2022]
Abstract
Background Renal dysfunction is frequently encountered in patients with aortic prosthesis degeneration requiring valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR). The effect of VIV TAVR on renal function in patients with bioprosthetic aortic regurgitation (AR) and stenosis (AS) is unknown. Objectives The aims of this study were to describe the change in renal function after VIV TAVR and to compare differences in renal function changes in those with predominant prosthetic regurgitation compared to stenosis. Methods All VIV TAVR between June of 2014, and October 2019 (n = 141) at a single institution were reviewed. Baseline renal function parameters including estimated glomerular filtration rate (eGFR) were compared with post-discharge follow-up values in both prosthetic AR and AS patient groups. Linear regression analysis was performed to determine correlates of renal function change. Results Mean baseline eGFR was lower in the AR group (55 SD21 vs. 64 SD24 ml/min/1.73 m2 p = 0.0495). At post-discharge follow-up there was an increase in mean eGFR in the AR group which was not present in the AS group (8 SD12 vs. 0 SD11 ml/min/1.73 m2 respectively p = 0.0006). There were strong correlations between change in creatinine (β = −0.57, R2 = 0.64, p < 0.0001) and BUN (β = −0.61, R2 = 0.51, p < 0.0001), and pre-procedure values in the AR group. Conclusions Patients who underwent VIV TAVR for AR experienced significant improvement of renal function at post-discharge follow-up. More advanced renal dysfunction at baseline was associated with greater improvement in renal function at post discharge in AR patients.
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Affiliation(s)
- Matthew S. Katz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kevin L. Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States
| | - Juan A. Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States
| | - Sunil V. Mankad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Mayra E. Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Hector I. Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Vuyisile T. Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Charanjit S. Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Mackram F. Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Corresponding author at: Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States.
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Kim PJH, Richards N, Feindel CMS, Butany J. Valve-in-valve prosthesis-late morphological findings. Cardiovasc Pathol 2021; 54:107345. [PMID: 33989796 DOI: 10.1016/j.carpath.2021.107345] [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: 02/03/2021] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022] Open
Abstract
Since its implantation in 2002, transcatheter aortic valve implantation (TAVI) has become the preferred intervention for patients with severe aortic stenosis and significant co-morbidities. In 2007, it was adopted as a rescue procedure for failed bioprosthetic valves, now known as the valve-in-valve (VIV) procedure. Unlike other modes of treatment with a multitude of phase 4 post-marketing surveillance (PMS) data, use of these valves have increased rapidly even without long term durability data on this procedure and the near lack of information on the pathology of failed transcatheter aortic valve replacement (TAVR) bioprosthesis and especially after the VIV procedure. We present a case of a late explanted VIV bioprosthesis (ten (10) years post-initial aortic valve replacement and five (5) years post-VIV procedure) in a 65-year-old male with multiple morphologic findings. Further availability of standardized morphologic data from explanted bioprosthetic valves is essential to aid in understanding the pathophysiology of tissue degeneration of the TAVI valve, and ultimately to improve patient outcomes by identifying possible early interventional strategies.
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Affiliation(s)
- Patrick J H Kim
- University of Toronto, Departments of Laboratory Medicine & Pathobiology & Departments of Pathology & Cardiovascular Surgery, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Natasha Richards
- University of Toronto, Departments of Laboratory Medicine & Pathobiology & Departments of Pathology & Cardiovascular Surgery, Toronto General Hospital, University Health Network, Toronto, Canada; Institute of Forensic Science and Legal Medicine, Ministry of National Security, 2(1/2) Hope Boulevard, Kingston 6, Jamaica
| | - Christopher M S Feindel
- Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Jagdish Butany
- University of Toronto, Departments of Laboratory Medicine & Pathobiology & Departments of Pathology & Cardiovascular Surgery, Toronto General Hospital, University Health Network, Toronto, Canada
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Borger MA, Raschpichler M, Makkar R. Repeat Aortic Valve Surgery or Transcatheter Valve-in-Valve Therapy. J Am Coll Cardiol 2020; 76:500-502. [DOI: 10.1016/j.jacc.2020.06.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
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Hahn RT, Nabauer M, Zuber M, Nazif TM, Hausleiter J, Taramasso M, Pozzoli A, George I, Kodali S, Bapat V, Maisano F. Intraprocedural Imaging of Transcatheter Tricuspid Valve Interventions. JACC Cardiovasc Imaging 2019; 12:532-553. [DOI: 10.1016/j.jcmg.2018.07.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 01/12/2023]
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7
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Reul RM, Ramchandani MK, Reardon MJ. Transcatheter Aortic Valve-in-Valve Procedure in Patients with Bioprosthetic Structural Valve Deterioration. Methodist Debakey Cardiovasc J 2018; 13:132-141. [PMID: 29743998 DOI: 10.14797/mdcj-13-3-132] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Surgical aortic valve replacement is the gold standard procedure to treat patients with severe, symptomatic aortic valve stenosis or insufficiency. Bioprosthetic valves are used for surgical aortic valve replacement with a much greater prevalence than mechanical valves. However, bioprosthetic valves may fail over time because of structural valve deterioration; this often requires intervention due to severe bioprosthetic valve stenosis or regurgitation or a combination of both. In select patients, transcatheter aortic valve replacement is an alternative to surgical aortic valve replacement. Transcatheter valve-in-valve (ViV) replacement is performed by implanting a transcatheter heart valve within a failing bioprosthetic valve. The transcatheter ViV operation is a less invasive procedure compared with reoperative surgical aortic valve replacement, but it has been associated with specific complications and requires extensive preoperative work-up and planning by the heart team. Data from experimental studies and analyses of results from clinical procedures have led to strategies to improve outcomes of these procedures. The type, size, and implant position of the transcatheter valve can be optimized for individual patients with knowledge of detailed dimensions of the surgical valve and radiographic and echocardiographic measurements of the patient's anatomy. Understanding the complexities of the ViV procedure can lead surgeons to make choices during the original surgical valve implantation that can make a future ViV operation more technically feasible years before it is required.
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Affiliation(s)
- Ross M Reul
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Mahesh K Ramchandani
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Michael J Reardon
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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Mosquera VX, González-Barbeito M, Bouzas-Mosquera A, Herrera-Noreña JM, Velasco C, Salgado-Fernández J, Calviño-Santos R, Vázquez-González N, Vázquez-Rodríguez JM, Cuenca-Castillo JJ. Efficacy and safety of transcatheter valve-in-valve replacement for Mitroflow bioprosthetic valve dysfunction. J Card Surg 2018; 33:356-362. [DOI: 10.1111/jocs.13720] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Victor X. Mosquera
- Department of Cardiac Surgery; Complejo Hospitalario Universitario de A Coruña; A Coruña Spain
| | | | | | - José M. Herrera-Noreña
- Department of Cardiac Surgery; Complejo Hospitalario Universitario de A Coruña; A Coruña Spain
| | - Carlos Velasco
- Department of Cardiac Surgery; Complejo Hospitalario Universitario de A Coruña; A Coruña Spain
| | | | - Ramón Calviño-Santos
- Department of Cardiology; Complejo Hospitalario Universitario de A Coruña; A Coruña Spain
| | | | | | - José J. Cuenca-Castillo
- Department of Cardiac Surgery; Complejo Hospitalario Universitario de A Coruña; A Coruña Spain
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Thourani VH, Borger MA, Holmes D, Maniar H, Pinto F, Miller C, Rodés-Cabau J, Mohr FW, Schröfel H, Moat NE, Beyersdorf F, Patterson GA, Weisel R. Transatlantic Editorial on Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2017; 104:1-15. [PMID: 28633216 DOI: 10.1016/j.athoracsur.2017.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Vinod H Thourani
- Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, Georgia.
| | - Michael A Borger
- Division of Cardiac Surgery, Department of Surgery, Columbia University, New York, New York
| | - David Holmes
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Hersh Maniar
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St. Louis, Missouri
| | - Fausto Pinto
- Department of Cardiology, University Hospital Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Craig Miller
- Department of Cardiac Surgery, Stanford University, Palo Alto, California
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Neil E Moat
- National Institute Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany
| | - G Alexander Patterson
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Richard Weisel
- Division of Cardiovascular Surgery, Peter Munk Cardiovascular Center, Toronto General Research Institute, Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada
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Thourani VH, Borger MA, Holmes D, Maniar H, Pinto F, Miller C, Rodés-Cabau J, Mohr FW, Schröfel H, Moat NE, Beyersdorf F, Patterson AG, Weisel R. Transatlantic Editorial on transcatheter aortic valve replacement. Eur J Cardiothorac Surg 2017; 52:1-13. [PMID: 28874024 DOI: 10.1093/ejcts/ezx196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/11/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Vinod H Thourani
- Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, GA, USA
| | - Michael A Borger
- Division of Cardiac Surgery, Department of Surgery, Columbia University, New York, NY, USA
| | - David Holmes
- Department of Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Hersh Maniar
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, MO, USA
| | - Fausto Pinto
- Department of Cardiology, University Hospital Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Craig Miller
- Department of Cardiac Surgery, Stanford University, Palo Alto, CA, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | | | | | - Neil E Moat
- Cardiovascular Biomedical Research Unit, National Institute Health Research, Royal Brompton Hospital and Harefield National Health Service Foundation Trust, London, UK
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Centre Freiburg University, Freiburg, Germany
| | - Alec G Patterson
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Richard Weisel
- Division of Cardiovascular Surgery, Peter Munk Cardiovascular Center, Toronto General Research Institute, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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Thourani VH, Borger MA, Holmes D, Maniar H, Pinto F, Miller C, Rodés-Cabau J, Mohr FW, Schröfel H, Moat NE, Beyersdorf F, Patterson GA, Weisel R. Transatlantic editorial on transcatheter aortic valve replacement. J Thorac Cardiovasc Surg 2017. [DOI: 10.1016/j.jtcvs.2017.03.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Loyalka P, Nascimbene A, Schechter M, Petrovic M, Sundara Raman A, Gregoric ID, Kar B. Transcatheter aortic valve implantation with a Sapien 3 Commander 20 mm valves in patients with degenerated 19 mm bioprosthetic aortic valve. Catheter Cardiovasc Interv 2017; 89:1280-1285. [PMID: 27696659 DOI: 10.1002/ccd.26723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 07/21/2016] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) in patients with degenerated bioprosthetic aortic valve has been successfully performed as an alternative to surgery. We describe our initial experience of valve-in-valve TAVI in five patients, using new generation Edwards Sapien 3 transcatheter heart valves implanted into degenerated 19 mm bioprosthetic valves. 20-mm Edwards S3 valves were offered for compassionate use. All patients had significant aortic valve stenosis. METHODS AND RESULTS The main vascular access was achieved and pre-closed with two Proglide closure devices in one patient and Prostar closure devices in four patients. For each TAVI procedure an Edwards 14 French sheath was inserted without complication and sutured in place. The Sapien 3 Commander delivery system was inserted and the valve was aligned in the descending aorta. The 20-mm Sapien 3 valve was deployed with slow continuous inflation during rapid right ventricular pacing. The cranial edge of the Edwards S3 valve was aligned with the cranial radiopaque markers of bioprosthesis to minimize paravalvular leak. Post-deployment angiography, transesophageal echocardiography and aortogram confirmed absence of mild aortic insufficiency and no increase in trans-aortic gradient when compared to a naïve 19 mm bioprosthetic valve. CONCLUSION Valve-in-valve TAVI with the Edwards S3 transcatheter heart valve for degenerative bioprosthetic aortic valves is technically feasible. The proper position of the stented valve minimizes the risk for post-procedure paravalvular insufficiency and provides good transaortic pressure gradient. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Pranav Loyalka
- Center for Advanced Heart Failure and Heart Transplantation, University of Texas Health Science Center, Houston, Texas
| | - Angelo Nascimbene
- Center for Advanced Heart Failure and Heart Transplantation, University of Texas Health Science Center, Houston, Texas
| | - Michael Schechter
- Center for Advanced Heart Failure and Heart Transplantation, University of Texas Health Science Center, Houston, Texas
| | - Marija Petrovic
- Center for Advanced Heart Failure and Heart Transplantation, University of Texas Health Science Center, Houston, Texas
| | - Ajay Sundara Raman
- Center for Advanced Heart Failure and Heart Transplantation, University of Texas Health Science Center, Houston, Texas
| | - Igor D Gregoric
- Center for Advanced Heart Failure and Heart Transplantation, University of Texas Health Science Center, Houston, Texas
| | - Biswajit Kar
- Center for Advanced Heart Failure and Heart Transplantation, University of Texas Health Science Center, Houston, Texas
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Loyalka P, Nascimbene A, Metz B, Gregoric ID, Raman AS, Kar B. Transcatheter Tricuspid Valve-in-Valve Replacement with an Edwards Sapien 3 Valve. Tex Heart Inst J 2017; 44:209-213. [PMID: 28761403 DOI: 10.14503/thij-15-5639] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A few case reports and case series have documented the outcomes in patients with tricuspid bioprosthetic valvular degeneration who underwent transcatheter implantation of the Medtronic Melody and the Edwards Sapien XT and Sapien 3 valves. In this report, we describe the case of a 49-year-old woman with severe bioprosthetic tricuspid valvular stenosis and multiple comorbidities who underwent transcatheter tricuspid valve replacement with a Sapien 3 valve.
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Gallo M, Dvir D, Demertzis S, Pedrazzini G, Berdajs D, Ferrari E. Transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic and mitral valves. Expert Rev Med Devices 2016; 13:749-58. [DOI: 10.1080/17434440.2016.1207521] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Paradis JM, Del Trigo M, Puri R, Rodés-Cabau J. Transcatheter Valve-in-Valve and Valve-in-Ring for Treating Aortic and Mitral Surgical Prosthetic Dysfunction. J Am Coll Cardiol 2015; 66:2019-2037. [DOI: 10.1016/j.jacc.2015.09.015] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/08/2015] [Indexed: 10/22/2022]
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Noorani A, Bapat V. Valve-in-Valve Therapy for Failed Surgical Bioprosthetic Valves: Clinical Results and Procedural Guidance. Interv Cardiol Clin 2015; 4:107-120. [PMID: 28582118 DOI: 10.1016/j.iccl.2014.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
With improved life expectancy and increased use of bioprosthetic heart valves, more elderly and frail patients present with degenerative surgical heart valve disease. The valve-in-valve procedure is an attractive alternative to a conventional open redo procedure. Although it is a novel extension of established transcatheter aortic valve implantation for severe aortic stenosis in a high-risk population, it is gaining momentum worldwide, particularly for aortic and mitral positions. Success depends on the operator being familiar with emerging transcatheter heart valve technology and morphology as well as that of the existing surgical heart valve, patient selection, accurate sizing, an ideal implantation position.
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Affiliation(s)
- Alia Noorani
- Department of Cardiothoracic Surgery, St Thomas' Hospital, 6th Floor, East Wing, London SE1 7EH, UK
| | - Vinayak Bapat
- Department of Cardiothoracic Surgery, St Thomas' Hospital, 6th Floor, East Wing, London SE1 7EH, UK.
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Raval J, Nagaraja V, Eslick GD, Denniss AR. Transcatheter valve-in-valve implantation: a systematic review of literature. Heart Lung Circ 2014; 23:1020-1028. [PMID: 25038030 DOI: 10.1016/j.hlc.2014.06.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 02/24/2014] [Accepted: 06/03/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) has become an alternative to open surgery in those deemed high risk. The purpose of this study was to evaluate the effectiveness and outcomes of this emerging procedure. We have examined available literature to provide an overview of valve-in-valve implantation using transcatheter heart valves (THVs) in aortic, mitral, pulmonary, tricuspid positions. METHODS A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane library, Google Scholar, Science Direct, and Web of Science. RESULTS Only 61 studies met full criteria and were included the review. This included 31 studies reporting transcatheter aortic valve-in-valve implantation, mitral valve-in-valve implantation (13 studies), tricuspid valve-in-valve implantation (12 studies), and pure native aortic valve regurgitation (nine studies). One of the limitations of this review is that most of the studies included were case reports, together with some case series. CONCLUSION Valve-in-valve implantation can be considered as an acceptable alternative to conventional open heart surgery for elderly high-risk surgical patients with bioprosthetic degeneration. Long-term follow-up of treated patients will be necessary to establish the true role of valve-in-valve implantation for bioprosthetic degeneration. Patients should be evaluated on an individual basis until outcomes are proven in large cohort studies or randomised trials.
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Affiliation(s)
- Jwalant Raval
- Department of Cardiology, Blacktown Hospital, and University of Western Sydney, Sydney, NSW, Australia.
| | - Vinayak Nagaraja
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, NSW, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, NSW, Australia
| | - A Robert Denniss
- Department of Cardiology, Blacktown Hospital, and University of Western Sydney, Sydney, NSW, Australia
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Blumenstein J, Van Linden A, Arsalan M, Moellmann H, Liebtrau C, Walther T, Kempfert J. Transapical access: current status and future directions. Expert Rev Med Devices 2014; 9:15-22. [DOI: 10.1586/erd.11.66] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Furukawa H, Tanemoto K. Redo Valve Surgery—Current Status and Future Perspectives. Ann Thorac Cardiovasc Surg 2014; 20:267-75. [DOI: 10.5761/atcs.ra.13-00380] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ferrari E. Transcatheter aortic "valve-in-valve" for degenerated bioprostheses: Choosing the right TAVI valve. Ann Cardiothorac Surg 2013; 1:260-2. [PMID: 23977505 DOI: 10.3978/j.issn.2225-319x.2012.07.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 07/31/2012] [Indexed: 11/14/2022]
Abstract
Bioprosthetic aortic valve replacement is the treatment of choice for patients over 65 years of age suffering from aortic valve disease, and for younger patients with contraindications to long-lasting anticoagulation. Despite several technical improvements to reduce the risk of structural valve degeneration (SVD), the risk of SVD still exists, in particular for hemodialysis patients and patients under 60 years of age at surgery. Redo open heart surgery is the treatment of choice in case of valve degeneration, but caries a higher surgical risk when elderly patients with comorbidities are concerned. In the last 5 years, transcatheter aortic "valve-in-valve" procedures represent a valid alternative to standard redo surgery in selected patients. Valve-in-valve procedures represent a less invasive approach in high-risk patients and the published results are very encouraging. Technical success rates of 100% have been reported, as have the absence of paravalvular leaks, acceptable trans-valvular gradients (depending on the size of the original bioprosthesis), and low complication rates. The current article focuses on choosing the correct transcutaneous valve to match the patient's existing bioprosthesis for valve-in-valve procedures.
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Affiliation(s)
- Enrico Ferrari
- Cardiovascular Surgery Department, University hospital of Lausanne, CH-1011, Lausanne, Switzerland
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22
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Furukawa H, Tanemoto K. Current status and future perspectives of prosthetic valve selection for aortic valve replacement. Gen Thorac Cardiovasc Surg 2013; 62:19-23. [PMID: 23722587 DOI: 10.1007/s11748-013-0262-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Indexed: 02/01/2023]
Abstract
Aortic valve abnormality is the most frequent form of valvular heart disease. Notably, aortic stenosis in the elderly population has been increasingly common. Aortic valve replacement (AVR) using prosthetic valve has been still believed as a gold standard surgical intervention for various types of diseased aortic valve. The numerous reports and studies evaluating the clinical outcomes and durability of prosthesis were revealed, however, prosthesis selection for AVR is still debated. In twenty-first century, paradigm shift of prosthesis preference might be emerged from mechanical valves to bioprosthesis due to the development of the technology. Moreover, transcatheter aortic valve implantation accelerated among the worldwide trends. It could be developed having the potential to reduce the mortality and morbidity associated with high-risk traditional AVR. After the current guidelines for the management of patients with valvular heart disease, we should consider the valve choice in various patients' profile setting. This review summarizes the current status of prosthesis selection and future perspectives of ideal aortic valve intervention, including minimal invasive care.
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Affiliation(s)
- Hiroshi Furukawa
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan,
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD, Harrington RA, Bhatt DL, Ferrari VA, Fisher JD, Garcia MJ, Gardner TJ, Gentile F, Gilson MF, Hernandez AF, Jacobs AK, Kaul S, Linderbaum JA, Moliterno DJ, Weitz HH. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement: developed in collabration with the American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Failure Society of America, Mended Hearts, Society of Cardiovascular Anesthesiologists, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Thorac Cardiovasc Surg 2012; 144:e29-84. [PMID: 22898522 DOI: 10.1016/j.jtcvs.2012.03.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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25
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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: 3.7] [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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The Valve-in-Valve Operation for Aortic Homograft Dysfunction: A Better Option. Ann Thorac Surg 2012; 94:731-5; discussion 735-6. [DOI: 10.1016/j.athoracsur.2012.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 03/31/2012] [Accepted: 04/04/2012] [Indexed: 11/20/2022]
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27
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Bruschi G, Barosi A, Colombo P, Botta L, Oreglia J, De Marco F, Paino R, Klugmann S, Martinelli L. Direct transatrial transcatheter SAPIEN valve implantation through right minithoracotomy in a degenerated mitral bioprosthetic valve. Ann Thorac Surg 2012; 93:1708-10. [PMID: 22541204 DOI: 10.1016/j.athoracsur.2011.08.084] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 08/21/2011] [Accepted: 08/29/2011] [Indexed: 11/17/2022]
Abstract
Transcatheter valve implantation into failing surgical mitral bioprosthetic valves have been reported. This strategy avoids performing high-risk repeat cardiac surgery in elderly patients with multiple comorbidities. All these patients have been treated by a transapical approach. We report a case of failing bioprosthetic mitral valve in an 82-year-old woman successfully treated with a 29-mm Edwards SAPIEN balloon expandable bioprosthesis (Edwards Lifesciences, Irvine, CA) with direct left atrial approach through a right anterior thoracotomy. Our experience demonstrates the technical feasibility and safety of this approach. Therefore, mitral valve-in-surgical valve implantation may be a viable treatment alternative in carefully selected patients.
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Affiliation(s)
- Giuseppe Bruschi
- Department of Cardiology and Cardiac Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
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28
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Azadani AN, Tseng EE. Transcatheter heart valves for failing bioprostheses: state-of-the-art review of valve-in-valve implantation. Circ Cardiovasc Interv 2012; 4:621-8. [PMID: 22186106 DOI: 10.1161/circinterventions.111.964478] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ali N Azadani
- Department of Surgery, University of California at San Francisco Medical Center, 500 Parnassus Avenue, San Francisco, CA 94143, USA
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29
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Kondo N, Shuto T, McGarvey JR, Koomalsingh KJ, Takebe M, Gorman RC, Gorman JH, Gillespie MJ. Melody valve-in-ring procedure for mitral valve replacement: feasibility in four annuloplasty types. Ann Thorac Surg 2012; 93:783-8. [PMID: 22364973 DOI: 10.1016/j.athoracsur.2011.12.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 12/05/2011] [Accepted: 12/06/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND The recurrence of regurgitation after surgical mitral valve (MV) repair remains a significant clinical problem. Mitral annuloplasty rings are commonly used in MV repair procedures. The purpose of this study was to demonstrate the feasibility of transvenous valve-in-ring (VIR) implantation using the Melody valve (Medtronic, Minneapolis, MN), which is a valved-stent designed for percutaneous pulmonary valve replacement, and 4 distinct types of annuloplasty ring (AR) in an ovine model. METHODS Ten sheep underwent surgical MV annuloplasty ring placement (n=10): CE-Physio, Edwards Lifesciences, Irvine, CA [n=5]; partial ring [n=3]; flexible ring [n=1]; and saddle ring [n=1]). All animals underwent cardiac catheterization, hemodynamic assessment, and Melody VIR implantation through a transfemoral venous, transatrial septal approach 1 week after surgery. Follow-up hemodynamic, angiographic, and echocardiographic data were recorded. RESULTS Melody VIR implantation was technically successful in all but 1 animal. In this animal a 26-mm partial AR proved too large for secure anchoring of the Melody valve. In the remaining 9 animals, fluoroscopy showed the Melody devices securely positioned within the annuloplasty rings. Echocardiography revealed no perivalvular leak, and angiography revealed no left ventricular outflow tract obstruction, vigorous left ventricular function, and no aortic valve insufficiency. The median procedure time was 55.5 (range, 45 to 78) minutes. CONCLUSIONS This study demonstrates the feasibility of a purely percutaneous approach to MV replacement in patients with preexisting annuloplasty rings, regardless of ring type. This approach may be of particular benefit to patients with failed repair of ischemic mitral regurgitation.
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Affiliation(s)
- Norihiro Kondo
- The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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30
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD, Harrington RA, Bhatt DL, Ferrari VA, Fisher JD, Garcia MJ, Gardner TJ, Gentile F, Gilson MF, Hernandez AF, Jacobs AK, Kaul S, Linderbaum JA, Moliterno DJ, Weitz HH. 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. Catheter Cardiovasc Interv 2012; 79:1023-82. [DOI: 10.1002/ccd.24351] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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31
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Petronio A, Giannini C, De Carlo M, Guarracino F. Antegrade percutaneous valve implantation for mitral ring dysfunction, a challenging case. Catheter Cardiovasc Interv 2012; 80:700-3. [PMID: 22511617 DOI: 10.1002/ccd.24307] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 12/21/2011] [Indexed: 11/12/2022]
Abstract
The operative risk for reoperation of degenerated bioprosthetic valves or failing mitral-valve annuloplasty is higher compared with the risks for first isolated native valve repair or replacement (Astor et al., Eur Heart J 2008;29:2382-2387). In the presence of comorbidities, these risks increase exponentially. The recent introduction of transcatheter valve implantation opened new perspectives for the treatment of patients at very high surgical risk. We report a percutaneous mitral valve (MV) implantation using a transatrial approach within a MV ring using the Edwars Sapien XT valve.
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Affiliation(s)
- Anna Petronio
- University of Pisa, Cardiothoracic and Vascular, Pisa, Italy.
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32
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD. 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2012; 93:1340-95. [PMID: 22300625 DOI: 10.1016/j.athoracsur.2012.01.084] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 01/26/2012] [Accepted: 01/26/2012] [Indexed: 12/20/2022]
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Eggebrecht H, Schäfer U, Treede H, Boekstegers P, Babin-Ebell J, Ferrari M, Möllmann H, Baumgartner H, Carrel T, Kahlert P, Lange P, Walther T, Erbel R, Mehta RH, Thielmann M. Valve-in-valve transcatheter aortic valve implantation for degenerated bioprosthetic heart valves. JACC Cardiovasc Interv 2012; 4:1218-27. [PMID: 22115663 DOI: 10.1016/j.jcin.2011.07.015] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 07/21/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We sought to analyze outcomes of patients with degenerated surgically implanted bioprosthetic heart valves undergoing valve-in-valve (viv) transcatheter aortic valve implantation (TAVI). BACKGROUND Redo cardiac surgery for degenerated bioprosthetic heart valves is associated with increased risks, particular in elderly patients with comorbidities. For these patients, TAVI may be an attractive, less invasive treatment option. METHODS Data from 47 patients age 64 to 97 years (logistic euroSCORE: 35.0 ± 18.5%) undergoing transfemoral (n = 25) or transapical (n = 22) viv-TAVI for failed bioprosthetic aortic valves 113 ± 65 months after initial surgery at 9 clinical sites in Germany and Switzerland were analyzed. RESULTS Valve-in-valve TAVI was technically successful in all patients, with 2 patients requiring bailout implantation of a second TAVI prosthesis for severe regurgitation during the procedure. There was 1 procedural death as the result of low-output failure. Valvular function after viv-TAVI was excellent with respect to valve competence, but increased transvalvular gradients ≥20 mm Hg were noted in 44% of patients. Vascular access complications occurred in 6 (13%) patients, and 5 (11%) patients required new pacemaker implantation after viv-TAVI. Renal failure requiring dialysis occurred in 4 (9%) patients. Mortality at 30 days was 17% (1 procedural and 7 post-procedural deaths), with 3 of 8 fatalities the result of non-valve-related septic complications. CONCLUSIONS Valve-in-valve TAVI can be performed with high technical success rates, acceptable post-procedural valvular function, and excellent functional improvement. However, in these predominantly elderly high-risk patients with multiple comorbidities, viv-TAVI was associated with 17% mortality, often because of septic complications arising in the post-operative phase.
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Affiliation(s)
- Holger Eggebrecht
- Department of Cardiology, West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany.
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Latib A, Ielasi A, Montorfano M, Maisano F, Chieffo A, Cioni M, Mussardo M, Bertoldi L, Shannon J, Sacco F, Covello RD, Figini F, Godino C, Grimaldi A, Spagnolo P, Alfieri O, Colombo A. Transcatheter valve-in-valve implantation with the Edwards SAPIEN in patients with bioprosthetic heart valve failure: the Milan experience. EUROINTERVENTION 2012; 7:1275-84. [DOI: 10.4244/eijv7i11a202] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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35
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Wilbring M, Sill B, Tugtekin SM, Alexiou K, Simonis G, Matschke K, Kappert U. Transcatheter Valve-in-Valve Implantation for Deteriorated Aortic Bioprosthesis: Initial Clinical Results and Follow-Up in a Series of High-Risk Patients. Ann Thorac Surg 2012; 93:734-41. [DOI: 10.1016/j.athoracsur.2011.11.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 11/03/2011] [Accepted: 11/03/2011] [Indexed: 10/14/2022]
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36
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Byrne J, Deshpande R, Young C, Thomas M. New and evolving indications for transcatheter aortic valve therapy. Interv Cardiol 2012. [DOI: 10.2217/ica.11.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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37
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol 2012; 59:1200-54. [PMID: 22300974 DOI: 10.1016/j.jacc.2012.01.001] [Citation(s) in RCA: 556] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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38
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Percutaneous transvenous Melody valve-in-ring procedure for mitral valve replacement. J Am Coll Cardiol 2012; 58:2475-80. [PMID: 22133846 DOI: 10.1016/j.jacc.2011.09.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 09/05/2011] [Accepted: 09/05/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The purpose of this study was to demonstrate the feasibility of percutaneous transvenous mitral valve-in-ring (VIR) implantation using the Melody valve in an ovine model. BACKGROUND The recurrence of mitral regurgitation following surgical mitral valve (MV) repair in both adult and pediatric patients remains a significant clinical problem. Mitral annuloplasty rings are commonly used in MV repair procedures and may serve as secure landing zones for percutaneous valves. METHODS Five sheep underwent surgical MV annuloplasty (24 mm, n = 2; 26 mm, n = 2; 28 mm, n = 1). Animals underwent cardiac catheterization with VIR implantation via a transfemoral venous, transatrial septal approach 1 week following surgery. Hemodynamic, angiographic, and echocardiographic data were recorded before and after VIR. RESULTS VIR was technically successful and required <1 h of procedure time in all animals. Fluoroscopy demonstrated securely positioned Melody valves within the annuloplasty ring in all animals. Angiography revealed no significant MV regurgitation in 4 and moderate central MV regurgitation in the animal with the 28-mm annuloplasty. All animals demonstrated vigorous left ventricular function, no outflow tract obstruction, and no aortic valve insufficiency. CONCLUSIONS This study demonstrated the feasibility of a purely percutaneous approach to MV replacement in patients with preexisting annuloplasty rings. This novel approach may be of particular benefit to patients with failed repair of ischemic mitral regurgitation and in pediatric patients with complex structural heart disease.
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Transcatheter Valve-in-Valve Implantation Using CoreValve Revalving System for Failed Surgical Aortic Bioprostheses. JACC Cardiovasc Interv 2011; 4:1228-34. [DOI: 10.1016/j.jcin.2011.10.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 10/03/2011] [Accepted: 10/05/2011] [Indexed: 11/24/2022]
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40
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Ferrari E. Transapical aortic ‘valve-in-valve’ procedure for degenerated stented bioprosthesis. Eur J Cardiothorac Surg 2011; 41:485-90. [DOI: 10.1093/ejcts/ezr027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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41
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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: 0.9] [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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Pasic M, Unbehaun A, Dreysse S, Buz S, Drews T, Kukucka M, Hetzer R. Transapical aortic valve implantation after previous aortic valve replacement: Clinical proof of the “valve-in-valve” concept. J Thorac Cardiovasc Surg 2011; 142:270-7. [DOI: 10.1016/j.jtcvs.2010.09.049] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 08/23/2010] [Accepted: 09/12/2010] [Indexed: 10/18/2022]
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Transcatheter Aortic Valve Implantation for Failing Surgical Aortic Bioprosthetic Valve. JACC Cardiovasc Interv 2011; 4:733-42. [DOI: 10.1016/j.jcin.2011.05.007] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/03/2011] [Accepted: 05/12/2011] [Indexed: 11/19/2022]
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Kiefer P, Gruenwald F, Kempfert J, Aupperle H, Seeburger J, Mohr FW, Walther T. Crimping May Affect the Durability of Transcatheter Valves: An Experimental Analysis. Ann Thorac Surg 2011; 92:155-60. [DOI: 10.1016/j.athoracsur.2011.03.020] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 03/09/2011] [Accepted: 03/09/2011] [Indexed: 11/29/2022]
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Piazza N, Bleiziffer S, Brockmann G, Hendrick R, Deutsch MA, Opitz A, Mazzitelli D, Tassani-Prell P, Schreiber C, Lange R. Transcatheter Aortic Valve Implantation for Failing Surgical Aortic Bioprosthetic Valve. JACC Cardiovasc Interv 2011; 4:721-32. [DOI: 10.1016/j.jcin.2011.03.016] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 03/24/2011] [Accepted: 03/31/2011] [Indexed: 10/18/2022]
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Kapetanakis EI, MacCarthy P, Monaghan M, Wendler O. Trans-apical aortic valve implantation in a patient with stentless valve degeneration. Eur J Cardiothorac Surg 2011; 39:1051-3. [DOI: 10.1016/j.ejcts.2010.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Revised: 10/28/2010] [Accepted: 11/04/2010] [Indexed: 11/25/2022] Open
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Walther T, Dehdashtian MM, Khanna R, Young E, Goldbrunner PJ, Lee W. Trans-catheter valve-in-valve implantation: in vitro hydrodynamic performance of the SAPIEN+cloth trans-catheter heart valve in the Carpentier-Edwards Perimount valves. Eur J Cardiothorac Surg 2011; 40:1120-6. [DOI: 10.1016/j.ejcts.2011.02.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 02/15/2011] [Accepted: 02/21/2011] [Indexed: 11/30/2022] Open
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Leontyev S, Borger MA, Davierwala P, Walther T, Lehmann S, Kempfert J, Mohr FW. Redo Aortic Valve Surgery: Early and Late Outcomes. Ann Thorac Surg 2011; 91:1120-6. [DOI: 10.1016/j.athoracsur.2010.12.053] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 12/24/2010] [Accepted: 12/29/2010] [Indexed: 11/27/2022]
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Azadani AN, Tseng EE. Transcatheter valve-in-valve implantation for failing bioprosthetic valves. Future Cardiol 2011; 6:811-31. [PMID: 21142638 DOI: 10.2217/fca.10.106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Transcatheter valve implantation is becoming an alternative to conventional surgical valve replacement in patients at high surgical risk. While experience and acceptance with transcatheter techniques increased rapidly, transcatheter valve implantation within failing bioprostheses has emerged as a new concept (valve-in-valve implantation). Currently, the majority of prostheses implanted in patients are bioprosthetic valves that are expected to degenerate over time. Valve-in-valve implantation provides great utility in high-operative-risk patients since the mortality risk for reoperation can be significantly higher than for first-time isolated valve replacement. Although two current devices are CE Mark approved in Europe for implantation within native valves, off-label clinical implementation of valve-in-valve have been described in numerous case reports. In this article, we provide an overview of transcatheter valve implantation in failing bioprostheses with an emphasis on the aortic position.
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Affiliation(s)
- Ali N Azadani
- Division of Cardiothoracic Surgery, University of California at San Francisco (UCSF) Medical Center, San Francisco, CA, USA.
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Kempfert J, Van Linden A, Holzhey D, Rastan A, Blumenstein J, Mohr FW, Walther T. The evolution of transapical aortic valve implantation and new perspectives. MINIM INVASIV THER 2011; 20:107-16. [DOI: 10.3109/13645706.2011.558101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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