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Sakata T, De La Pena C, Ohira S. Rapid-Deployment Aortic Valve Replacement: Patient Selection and Special Considerations. Vasc Health Risk Manag 2023; 19:169-180. [PMID: 37016696 PMCID: PMC10066891 DOI: 10.2147/vhrm.s374410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Sutureless or rapid deployment valves in the setting of aortic valve replacement (AVR) is an emerging surgical technique using the transcatheter valve technology, which may lead to reduction in cross-clamp time and potentially better hemodynamics compared to a stented bioprosthetic valve. The absence of subannular pledgets results to excellent hemodynamic performance with reduced turbulent flow and larger effective orifice area. However, complications from both surgical and transcatheter AVR may still occur and impact survival. The incidence of paravalvular leakage and permanent pacemaker implantation are not low. Although technical modifications can improve these outcomes, there is a learning curve effect. Therefore, technical and anatomical considerations as well as better patient selection are paramount for better outcomes. In this review, we discuss the use of sutureless or rapid deployment valves in setting of (1) complex procedures, (2) minimally invasive AVR, and (3) small aortic annulus. The advantage of sutureless or rapid deployment valves in terms of mortality remains to be clarified; therefore, it is necessary to accumulate long-term outcomes in an appropriate patient cohort.
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Affiliation(s)
- Tomoki Sakata
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Corazon De La Pena
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Suguru Ohira
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
- Correspondence: Suguru Ohira, Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, 100 Woods Road, Macy Pavilion, Valhalla, NY, 10595, USA, Tel +1 404 234 5433, Email
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Valve-in-valve transcatheter aortic valve implantation for the failing surgical Perceval bioprosthesis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40S:148-153. [PMID: 34412989 DOI: 10.1016/j.carrev.2021.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The Perceval Valve has been increasingly used in Surgical Aortic Valve Replacement (SAVR) recently due to ease of implantation. However, we have seen some cases of relatively early haemodynamic failure of the Perceval valve and these patients may then present for valve-in-valve transcatheter aortic valve implantation (ViV-TAVI). Experience of ViV-TAVI in the Perceval valve is limited. METHODS We report our experience of VIV-TAVI in four cases of early-failing Perceval valves, two with stenosis and two with regurgitation. We also review the literature with regard to ViV-TAVI for this indication. RESULTS Four patients aged between 66 and 78 years presented with Perceval valve dysfunction an average of 4.6 years following SAVR. All cases underwent Heart Team discussion and a ViV-TAVI procedure was planned thereafter. Strategies to ensure crossing through the centre of the valve and not outside any portion of the frame were found to be essential. Three patients had self-expanding valves implanted and one had a balloon-expandable prosthesis. The average aortic valve area (AVA) improved from 0.8 cm2 pre-procedure to 1.5 cm2 post-procedure*. The mean gradient (MG) improved from 35.5 mmHg (range 19.7-53 mmHg) pre-procedure to 14.8 mmHg (range 7-30 mmHg) post-procedure. In one patient a MG of 30 mmHg persisted following valve deployment. There were no significant peri-procedural complications. CONCLUSIONS ViV-TAVI is a useful option for failed Perceval prostheses and appears safe and effective in this small series. Crossing inside the whole frame of the Perceval valve is essential.
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Misfeld M, Abdel-Wahab M, Thiele H, Borger MA, Holzhey D. A series of four transcatheter aortic valve replacement in failed Perceval valves. Ann Cardiothorac Surg 2020; 9:280-288. [PMID: 32832409 DOI: 10.21037/acs-2020-surd-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In recent years, sutureless valves (SV) and rapid deployment valves (RDVs) have become interesting aortic valve substitutes, especially in minimally invasive aortic valve surgery, as they reduce cardio-pulmonary bypass and cross-clamp times. There are two valve types available, the sutureless Perceval and the rapid deployment Intuity valve prosthesis. When these valves fail, besides surgical re-replacement, the valve-in-valve concept has been reported in a small series of case reports. Our own experience includes four cases of failed Perceval valves, in which a balloon-expandable transcatheter valve was implanted in three patients, and a self-expanding transcatheter valve was implanted in a fourth patient. Here, we present these four cases with a focus on the specific valve design of the Perceval valve, as well as on important technical aspects. All cases were performed successfully with clinical improvement. Transcatheter aortic valve replacement (TAVR) as a valve-in-valve concept seems to be a valuable option in selected patients with failed sutureless or RDVs.
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Affiliation(s)
- Martin Misfeld
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Holger Thiele
- Clinic of Cardiology, Leipzig Heart Center, Leipzig, Germany
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - David Holzhey
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
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Cinelli M, Schwartz L, Spagnola J, Gulkarov I, Rosell F, Lackey A, Imam M, Schwartz C. Early Structural Deterioration of a Sutureless Bioprosthetic Aortic Valve. Cardiol Res 2020; 11:113-117. [PMID: 32256918 PMCID: PMC7092772 DOI: 10.14740/cr1013] [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: 01/27/2020] [Accepted: 02/18/2020] [Indexed: 11/29/2022] Open
Abstract
Sutureless bioprosthetic valves such as the Sorin Perceval S valve (SPV) have been used in patients with aortic stenosis that require surgical aortic valve replacement (SAVR). These prostheses have been marketed on the basis of their rapid implantation techniques with avoidance of sutures and reduced aortic cross-clamp times. We report a case of an early failure of a SPV nearly 4 years after implantation in a 58-year-old woman who was low-risk. While the patient’s symptoms initially improved with SAVR with a sutureless bioprosthetic valve, they progressively worsened as the valve degraded, and the leaflets became increasingly calcified and stenotic ultimately, requiring reoperative SAVR with a St. Jude mechanical valve. This case raises the issue of the lack of much-needed data describing the long-term durability and hemodynamic performance of these valves, particularly in a low-risk patient with excellent functional status. We hope to shed further insight into the lack of long-term studies on patients with SPV to assess their longevity and long-term effectiveness, as well as elucidation of possible prevention and monitoring of these potential complications. The use of newer generation prostheses, although attractive for their ease of implantation, potentially carries higher long-term risk due to shorter durability leading to reintervention to address valve deterioration. This is especially true in low-risk patients who are young and active. Cardiology and cardiothoracic surgery societies need to develop a universal registry with follow-up of all valves in order to track and study the durability of these valves, and to evaluate for incidence of known and potential complications.
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Affiliation(s)
- Michael Cinelli
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Leonard Schwartz
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Jonathan Spagnola
- Division of Cardiology, Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Iosif Gulkarov
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Frank Rosell
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Adam Lackey
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Mohammed Imam
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA
| | - Charles Schwartz
- Division of Cardiology, Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
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Ellouze M, Mazine A, Carrier M, Bouchard D. Sutureless and Transcatheter Aortic Valve Replacement: When Rivals Become Allies. Semin Thorac Cardiovasc Surg 2019; 32:427-430. [PMID: 31330180 DOI: 10.1053/j.semtcvs.2019.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/06/2019] [Indexed: 11/11/2022]
Abstract
In recent years, sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve replacement (TAVR) have emerged as viable alternatives to standard surgical aortic valve replacement (AVR) in higher risk patients. We report 7 cases in which SU-AVR and TAVR were used as bailout procedures for each other. Between June 2011 and August 2018, 626 patients underwent SU-AVR with the Perceval S prosthesis, and 588 patients underwent TAVR at the Montreal Heart Institute. Herein, we report the cases of 7 patients who underwent both procedures within a short time frame: 3 patients who underwent SU-AVR with a Perceval prosthesis after a failed TAVR procedure, 3 patients who underwent TAVR after degeneration of a surgically implanted Perceval sutureless prosthesis, and 1 patient who was scheduled for multiple percutaneous interventions-including TAVR, right coronary angioplasty, atrial fibrillation ablation with left atrial appendage occlusion-who suffered a periprocedural complication requiring an emergent surgery, during which a Perceval sutureless prosthesis was deployed. All patients were discharged home alive. Two patients suffered a complete heart block requiring permanent pacemaker implantation. We demonstrate that SU-AVR with the Perceval S prosthesis and TAVR are complementary procedures within the therapeutic armamentarium to treat aortic valve disease in higher risk patients. Specifically, valve-in-valve TAVR is an attractive option in the setting of Perceval prosthesis degeneration, whereas SU-AVR is a useful bailout option in the context of periprocedural failure of a TAVR.
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Affiliation(s)
- Mariam Ellouze
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Québec, Canada
| | - Amine Mazine
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Québec, Canada
| | - Michel Carrier
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Québec, Canada
| | - Denis Bouchard
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Québec, Canada.
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Kosmas I, Iakovou I, Leontiadis E, Sbarouni E, Georgiadou P, Bousoula E, Aravanis N, Stratinaki M, Voudris V, Mpalanika M. The first transcatheter valve-in-valve implantation of a self-expandable valve for the treatment of a degenerated sutureless aortic bioprosthesis. Hellenic J Cardiol 2019; 61:49-50. [PMID: 31039413 DOI: 10.1016/j.hjc.2019.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/05/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- I Kosmas
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece.
| | - I Iakovou
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece
| | - E Leontiadis
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece
| | - E Sbarouni
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece
| | - P Georgiadou
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece
| | - E Bousoula
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece
| | - N Aravanis
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece
| | - M Stratinaki
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece
| | - V Voudris
- Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Greece
| | - M Mpalanika
- Department of Anaesthesiology, Onassis Cardiac Surgery Center, Greece
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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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Lazkani M, Yerasi C, Prakash S, Pershad A, Fang K. Permanent pacemaker implantation and paravalvular leak rates following sutureless aortic valve operations. J Card Surg 2018; 33:808-817. [DOI: 10.1111/jocs.13938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Mohamad Lazkani
- University of Colorado HealthMedical Center of the RockiesLovelandColorado
| | | | - Sheena Prakash
- University of ArizonaBanner University Medical CenterPhoenixArizona
| | - Ashish Pershad
- University of ArizonaBanner University Medical CenterPhoenixArizona
| | - Kenith Fang
- University of ArizonaBanner University Medical CenterPhoenixArizona
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Seckeler MD, White SC, Jenkins J, Klewer SE. Treatment of tricuspid regurgitation and para-ring leak in tetralogy of Fallot with oversized SAPIEN 3 valve-in-ring implantation. J Card Surg 2018; 33:541-544. [PMID: 29998581 DOI: 10.1111/jocs.13770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 40-year-old female with previously repaired tetralogy of Fallot had recurrent severe tricuspid regurgitation with a para-ring leak after annuloplasty ring placement. Because of multiple prior sternotomies and co-morbidities, she was not felt to be a surgical candidate. Percutaneous placement of an oversized SAPIEN 3 valve-in-ring in the tricuspid position successfully treated the regurgitation and para-ring leak.
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Affiliation(s)
- Michael D Seckeler
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, Arizona
| | - Shelby C White
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, Arizona
| | | | - Scott E Klewer
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, Arizona
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