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Conzelmann L, Grotherr P, Dapeng L, Würth A, Widder J, Jacobshagen C, Mehlhorn U. Valve-Related Complications in TAVI Leading to Emergent Cardiac Surgery. Thorac Cardiovasc Surg 2023; 71:107-117. [PMID: 36446625 DOI: 10.1055/s-0042-1758073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is now a standard procedure for the treatment of symptomatic aortic valve stenosis in many patients. In Germany, according to the annual reports from the German Institute for Quality Assurance and Transparency in Healthcare (Institut für Qualitätssicherung und Transparenz im Gesundheitswesen), the rate of serious intraprocedural complications, such as valve malpositioning or embolization, coronary obstruction, aortic dissection, annular rupture, pericardial tamponade, or severe aortic regurgitation requiring emergency cardiac surgery has decreased markedly in recent years from more than 5.5% in 2012 to 2.0% in 2019. However, with increased use, the total number of adverse events remains about 500 per year, about 100 of which require conversion to sternotomy. These, sometimes, fatal events can occur at any time and are still challenging. Therefore, the interdisciplinary TAVI heart team should be prepared and aware of possible rescue strategies.
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Affiliation(s)
- Lars Conzelmann
- Department of Cardiac Surgery, HELIOS Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany
| | - Philipp Grotherr
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Lu Dapeng
- Department of Cardiology, Intensive Care Medicine and Angiology, Vincentius-Diakonissen Hospital Karlsruhe, Karlsruhe, Germany
| | - Alexander Würth
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Julian Widder
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Claudius Jacobshagen
- Department of Cardiology, Intensive Care Medicine and Angiology, Vincentius-Diakonissen Hospital Karlsruhe, Karlsruhe, Germany
| | - Uwe Mehlhorn
- Department of Cardiac Surgery, HELIOS Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany
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2
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Helmy T, Kumar S, Khan AA, Raza A, Smart S, Bailey SR. Review of Prosthetic Paravalvular Leaks: Diagnosis and Management. Curr Cardiol Rep 2022; 24:1287-1297. [PMID: 36152141 DOI: 10.1007/s11886-022-01744-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Paravalvular leak (PVL) is a relatively uncommon complication associated with prosthetic valve implantation. PVL can occasionally lead to serious adverse consequences such as congestive heart failure, infective endocarditis, and hemolytic anemia. Surgical re-operation carries a high mortality risk. RECENT FINDINGS Transcatheter closure therapy provides a viable alternative for the treatment of this disorder with reasonable procedural and clinical success. The recent advent of hybrid imaging modalities has increased procedural success. This article summarizes the pathophysiology, clinical characteristics, and treatment modalities surroundings prosthetic paravalvular leak.
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Affiliation(s)
- Tarek Helmy
- Division of Cardiovascular Medicine, Louisiana State University School of Medicine, Shreveport, LA, USA.
| | - Sundeep Kumar
- Division of Cardiovascular Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Abdul A Khan
- Division of Cardiovascular Medicine, Louisiana State University School of Medicine, Shreveport, LA, USA
| | - Ali Raza
- Division of Cardiovascular Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Steven Smart
- Division of Cardiovascular Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Steven R Bailey
- Division of Cardiovascular Medicine, Louisiana State University School of Medicine, Shreveport, LA, USA
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3
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Dreger H, Sündermann S, Niehues SM, Landmesser U. Bail-Out Implantation of an Embolized Balloon-Expandable Transcatheter Heart Valve in the Aortic Arch Using Self-Expandable Stents. Am J Cardiol 2022; 180:163-164. [DOI: 10.1016/j.amjcard.2022.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
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4
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Successful Treatment of Severe Paravalvular Leak by Repositioning a Self-Expandable Percutaneous Aortic Valve Bioprosthesis (Evolut PRO+) Using the “Double Snare” Technique. Case Rep Cardiol 2022; 2022:4458109. [PMID: 35425645 PMCID: PMC9005318 DOI: 10.1155/2022/4458109] [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: 10/29/2021] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
Significant (moderate or severe) paravalvular leak (PVL) after transcatheter aortic valve replacement (TAVR) remains a common phenomenon and has been associated with decrease survival and quality of life. Transcatheter valve embolization and migration (TVEM) is a rare post-TAVR complication that can occur in 1% of cases and has been associated with worse patient outcomes. Valve embolization or migration into the left ventricle can result in significant PVL causing hemodynamic instability, shock, heart failure, and hemolytic anemia. Although this complication most commonly occurs in the acute setting (90%) within 4 hours of TAVR, it can also present late (4 hr-43 days later) in 10% of cases. There are no clear guidelines as to how this condition should be managed; however, several percutaneous bailout techniques exist that can ultimately spare the patient from emergent cardiovascular surgery. We present a rare case of late ventricular transcatheter aortic valve migration 3 days after TAVR causing severe PVL and heart failure symptoms that was successfully treated using the percutaneous “double snare” technique.
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5
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Micro-dislodgement of a self-expanding transcatheter heart valve: Incidence, predictors, and outcomes. Int J Cardiol 2022; 358:77-82. [DOI: 10.1016/j.ijcard.2022.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/20/2022]
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6
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Zhang P, Li F, Wang Y, Wang X, Xu D, Qiao E, Zhao S, Wu Y, Wang W. Long-Term Outcomes of Patients with Self-Expandable Transcatheter Heart Valve Embolized in the Aorta. Int Heart J 2021; 62:1265-1272. [PMID: 34853220 DOI: 10.1536/ihj.21-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study assesses the long-term outcomes of patients who suffered from self-expandable transcatheter heart valve (THV) embolized in the aorta in transcatheter aortic valve implantation (TAVI).We retrospectively reviewed the patients with self-expandable THV embolized in the aorta. Follow-up computed tomography was performed to assess the THV migration, struct fractures, and device-related aortic complications.Of the 539 TAVI patients, 11 suffered from self-expandable THV embolized in the aorta. Two patients underwent open-heart surgery to remove the embolized THVs in the ascending aorta. Embolized THVs were repositioned in the aortic arch distal to the left subclavian artery (n = 3) and the thoracic descending aorta (n = 6). Three patients died during a median follow-up time of 40 months. The remaining eight survivors presented with New York Heart Association functional class I or II at the last follow-up. Degeneration of embolized prostheses with thick leaflets and rolled cusp edges was observed in three patients. There was no evidence of valve migration, strut fracture, prosthesis-associated aortic complication, and thrombosis attached on embolized valve for all patients with THVs repositioned in the aorta.Self-expandable THV embolization can be effectively managed in TAVI. Although some embolized valves exhibited leaflet degeneration, the long-term safety of repositioning embolized self-expandable THV in the aorta is assured.
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Affiliation(s)
- Peide Zhang
- Department of Cardiac Intensive Care Unit, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.,National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases
| | - Fei Li
- Department of Cardiac Surgery, Peking University First Hospital.,Department of Structural Heart Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.,National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases
| | - Yuetang Wang
- Department of Structural Heart Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.,National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases
| | - Xu Wang
- Department of Structural Heart Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.,National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases
| | - Donghui Xu
- Department of Structural Heart Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.,National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases
| | - En Qiao
- Department of Structural Heart Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.,National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases
| | - Shihua Zhao
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases.,Department of Magnetic Resonance Imaging, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yongjian Wu
- Department of Structural Heart Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.,National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases
| | - Wei Wang
- Department of Structural Heart Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.,National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases
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Saltiel A, Rabinovich Y, Rubinstein C, Atamna O, Finkelstein A, Sheick-Yousif B. A novel endovascular treatment for transcatheter aortic valve embolization. J Vasc Surg Cases Innov Tech 2021; 7:755-758. [PMID: 34805651 PMCID: PMC8585581 DOI: 10.1016/j.jvscit.2021.10.010] [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: 07/21/2021] [Accepted: 10/14/2021] [Indexed: 11/25/2022] Open
Abstract
In the present report, we have described the case of an 82-year-old obese man who had required transcatheter aortic valve replacement to treat severe symptomatic aortic stenosis. During implantation, the balloon-mounted valve became dislodged and embolized to the ascending aorta. A second valve was successfully implanted after several failed attempts to reposition the first one into the aortic annulus. The dislodged valve became further embolized and landed in the distal descending aorta, partially obstructing the splanchnic, renal, and lower extremity blood flow. It was rotated with flexible forceps and permanently secured in the distal thoracic aorta using a thoracic endoprosthesis, rendering it harmless.
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8
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Valve-in-valve procedure after CoreValve pop-out. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:324-326. [PMID: 34819974 PMCID: PMC8596719 DOI: 10.5114/aic.2021.109157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
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9
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Bricker RS, Cleveland JC, Messenger JC. Mechanical Complications of Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2021; 10:465-480. [PMID: 34593110 DOI: 10.1016/j.iccl.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Mechanical complications after transcatheter aortic valve replacement are fortunately rare with the current generation of devices. Unfortunately, life-threatening complications will occur and it is the responsibility of operators to be familiar with strategies to prevent and manage these challenging scenarios. Because these cases will not occur often, it is important for us to highlight and talk about those that do occur, to learn best practices in how to manage and prevent them going forward. We can learn much from each other's good crash landings.
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Affiliation(s)
- Rory S Bricker
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, 12631 East 17th Avenue, B130, Aurora, CO 80045, USA
| | - Joseph C Cleveland
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, 6111, Aurora, CO 80045, USA
| | - John C Messenger
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, 12631 East 17th Avenue, B130, Aurora, CO 80045, USA.
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Li J, Sun Y, Zheng S, Li G, Dong H, Fu M, Mo Y, Li Y, Liu H, Xu Z, Zhang L, Cao Y, Fan R, Lim DS, Luo J. Anatomical Predictors of Valve Malposition During Self-Expandable Transcatheter Aortic Valve Replacement. Front Cardiovasc Med 2021; 8:600356. [PMID: 34322521 PMCID: PMC8311434 DOI: 10.3389/fcvm.2021.600356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The consequence of valve malposition (VM) during transcatheter aortic valve replacement (TAVR) can be severe, but the determinants of VM with self-expandable TAVR have not been thoroughly evaluated. We aimed to investigate the anatomical predictors of VM during self-expandable TAVR. Methods: In this multicenter retrospective study, TAVR was performed using the Venus A-Valve. The baseline, computed tomography, and procedural characteristics along with clinical outcomes were collected. Multivariate logistic regression model and receiver operating characteristic (ROC) curve analyses were performed. Results: A total of 84 consecutive patients (23 with VM) were included. Stepwise regression showed that annulus perimeter/left ventricular outflow tract perimeter (AL ratio) and sinotubular junction (STJ) height were predictors of VM. The ROC curve indicated a moderate strength of AL ratio [area under the curve (AUC) 0.71, cutoff 0.96] and a weak strength of STJ height (AUC 0.69, cutoff 23.8 mm) to predict VM. The combination of both predictors revealed a higher predictive value of VM (AUC 0.77). In multivariate analysis, AL ratio <0.96 [odds ratio (OR) 3.98, p = 0.015] and STJ height ≥23.8 mm (OR 4.63, p = 0.008) were strong independent predictors of VM. The presence of both predictors was associated with a very high risk of VM (OR 10.67, p = 0.002). The rate of moderate-to-severe paravalvular regurgitation was higher in patients with VM at 30 days (26.1 vs. 4.9%, p = 0.011). Conclusions: A conical left ventricular outflow tract and tall aortic sinuses were strong anatomical predictors of VM during self-expandable TAVR.
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Affiliation(s)
- Jie Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yinghao Sun
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shengneng Zheng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guang Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haojian Dong
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ming Fu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yujing Mo
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi Li
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | - Zhaoyan Xu
- The First People Hospital of Foshan, Foshan, China
| | - Liting Zhang
- Zhongshan City People's Hospital, Zhongshan, China
| | - Yong Cao
- Gaozhou People's Hospital, Gaozhou, China
| | - Ruixin Fan
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - D Scott Lim
- University of Virginia Health System Hospital, Virginia, NV, United States
| | - Jianfang Luo
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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11
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Wunderlich NC, Honold J, Swaans MJ, Siegel RJ. How to Image and Manage Prosthesis-Related Complications After Transcatheter Aortic Valve Replacement. Curr Cardiol Rep 2021; 23:94. [PMID: 34196775 DOI: 10.1007/s11886-021-01522-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW In this review, we provide an overview of potential prosthesis - related complications after transcatheter aortic valve replacement, their incidences, the imaging modalities best suited for detection, and possible strategies to manage these complications. RECENT FINDINGS Therapy for severe aortic valve stenosis requiring intervention has increasingly evolved toward transcatheter aortic valve replacement over the past decade, and the number of procedures performed has increased steadily in recent years. As more and more centers favor a minimalistic approach and largely dispense with general anesthesia and intra-procedural imaging by transesophageal echocardiography, post-procedural imaging is becoming increasingly important to promptly detect dysfunction of the transcatheter valve and potential complications. Complications after transcatheter aortic valve replacement must be detected immediately in order to initiate adequate therapeutic measures, which require a profound knowledge of possible complications that may occur after transcatheter aortic valve replacement, the imaging modalities best suited for detection, and available treatment options.
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Affiliation(s)
| | - Jörg Honold
- Cardiovascular Center Darmstadt, Darmstadt, Germany
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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12
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A Completely Endovascular Solution for Transcatheter Aortic Valve Implantation Embolisation and Inversion into the Aortic Arch. EJVES Vasc Forum 2021; 52:13-16. [PMID: 34278368 PMCID: PMC8264528 DOI: 10.1016/j.ejvsvf.2021.06.003] [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: 10/12/2020] [Revised: 05/17/2021] [Accepted: 06/03/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Transcatheter aortic valve implantation (TAVI) has evolved into the preferred alternative to surgical valve replacement for severe aortic valve stenosis with high surgical risk. With expanding indications, life threatening complications including transcatheter aortic valve embolisation and inversion (TAVEI), in which the valve dislodges, inverts, and migrates caudally, may increase concomitantly. Report An 80 year old male with severe aortic valve stenosis underwent balloon expandable transcatheter aortic valve implantation (TAVI). Valve embolisation into the aortic arch inverted the bioprothesis, excluding the option of fixation in the descending aorta. Through-valve thoracic endovascular aortic repair (TEVAR) was performed after bifemoral snaring using a through-and-through wire technique and pulling the valve into the descending aorta. Discussion TAVI is emerging as the preferred treatment for severe aortic valve stenosis and comes with unique procedural complications, such as life threatening transcatheter aortic valve embolisation and inversion (TAVEI). Although some authors prefer treating embolisation of a non-inverted balloon expandable valve into the aorta by using the valvuloplasty balloon to pull the valve distally and fixing it in the descending aorta, this risks further expansion of the valve and consequently fixing it in an undesirable position and is not possible if the valve inverts. Downstream placement of the valve by snaring with a guiding catheter covering/protecting a through-and-through wire technique, combined with through-valve TEVAR, provides a new bail out strategy for this serious complication and may reduce TAVEI associated mortality and morbidity. TAVI is preferred to open replacement when treating severe aortic valve stenosis. An embolized valve may invert (TAVEI) risking hemodynamical obstruction. Snaring with a through-and-through wire allows downstream valve placement. A covered through-and-through wire protects the aortic wall during snaring. Thoracic stent-grafting provides a completely endovascular solution for TAVEI.
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13
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Tsuda M, Shutta R, Nishino M, Tanouchi J. Implantation of three transcatheter aortic valves for embolization of two valves caused by under-expansion: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytaa497. [PMID: 33644651 PMCID: PMC7898586 DOI: 10.1093/ehjcr/ytaa497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/28/2020] [Accepted: 11/28/2020] [Indexed: 12/03/2022]
Abstract
Background Transcatheter aortic valve embolization is one of the serious complications of transcatheter aortic valve implantation (TAVI). We present a case of TAVI that needed implantation of three transcatheter aortic valves owing to the embolization of two self-expandable valves (SEVs). Case summary An 88-year-old woman underwent TAVI using a 26-mm SEV. After valve deployment, the SEV embolized to the ascending aorta during the removal of the delivery system (DS) of the SEV (DS-SEV) from the SEV. An additional SEV was implanted, which also embolized upwards. Multi-directional fluoroscopy revealed extreme under-expansion of the second SEV, which caused valve embolization due to catching of the DS-SEVs in the SEVs. Finally, a 23-mm balloon-expandable valve was successfully implanted, which was also under expanded on fluoroscopic assessment. The patient was stable without sequelae at the 1-month follow-up. Discussion Pre-procedurally predicting SEV under-expansions was difficult because pre-procedural computed tomography revealed no massive calcification on the aortic valve, and fluoroscopy indicated adequate expansion of the SEVs at the angle where the valves were deployed. We verified the possibility of catching of a DS-SEV in an under-expanded SEV in an in vitro test, which showed that the DS-SEV was caught in the extremely under-expanded SEV. Furthermore, balloon dilation might release the catch of the DS-SEV by changing the DS-SEV position. Therefore, we recommend performing multi-directional fluoroscopy to evaluate SEV expansion before DS-SEV removal from an SEV. Furthermore, if catching of a DS-SEV occurs, balloon dilation might be useful for releasing the catch and safely removing the DS-SEV.
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Affiliation(s)
- Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, Osaka, Japan
| | - Ryu Shutta
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, Osaka, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, Osaka, Japan
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, Osaka, Japan
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14
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Hale SM, Jessen M, Banerjee S, Kumbhani DJ. Successful transcatheter treatment for very late migration of a transcatheter aortic valve into the left ventricular outflow tract. Catheter Cardiovasc Interv 2021; 97:1492-1495. [PMID: 33565698 DOI: 10.1002/ccd.29547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/05/2021] [Accepted: 01/23/2021] [Indexed: 11/11/2022]
Abstract
Although rare, embolization or migration of transcatheter aortic valves into the left ventricle has been described. We report a case of very late migration of an Edwards Sapien XT (Edwards Lifescience Corporation, Irvine, California) valve that was placed 4 years prior to the development of recurrent severe aortic stenosis with the transcatheter heart valve situated below the native stenotic aortic valve in the left ventricular outflow tract. The management options in this scenario, and outline how they successfully treated this challenging case with transfemoral TAV-in-TAV have also been discussed.
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Affiliation(s)
- Seth M Hale
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Jessen
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Subhash Banerjee
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dharam J Kumbhani
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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15
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Carli AG, Perini P, Vignali L, Bianchini Massoni C, Fanelli M, Freyrie A. Loss of Prosthetic Aortic Valve during TAVI Procedure: Endovascular Treatment in Emergent Setting. Ann Vasc Surg 2021; 73:585-588. [PMID: 33556523 DOI: 10.1016/j.avsg.2020.12.044] [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: 09/09/2020] [Revised: 12/04/2020] [Accepted: 12/30/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has proven over the years to be a viable alternative to open surgery. A rare but severe complication is represented by the valve migration. We report a case of TAVI complication due to the loss of the prosthetic valve in the abdominal aorta treated by endovascular approach. METHODS An 88-year-old patient with severe aortic valve stenosis, symptomatic for dyspnea was proposed for a TAVI because considered at high risk for surgery. During the TAVI procedure, the undeployed device (Edwards SAPIEN 3 - Edwards Lifesciences, Irvine, CA, USA) detached from its delivery system. Several attempts to withdraw the valve fluctuating in the aorta into its supporting system were performed without success. An emergency endovascular treatment was promptly planned to obtain the exclusion from the flow of the embolized valve. Under local anaesthesia, through the percutaneous femoral access already present, a tube aortic endograft (EndurantTM II, Medtronic, Santa Rosa, CA; ETTF2828C70EE) was successfully introduced and deployed in the infrarenal aorta without any related complications. The embolized valve was completely covered by the endgraft and thus fixed to the aortic wall. The first postoperative computer tomography angiography (CTA) confirmed the correct placement of the endograft, the exclusion of the valve from the flow and the patency of the great vessels. No perioperative or postoperative complications were recorded. The patient was discharged on the ninth postoperative day with the indication to a new attempt of TAVI, through transapical access. CONCLUSIONS In case of intraprocedural loss of an undeplyed valve during TAVI, the valve fixing through endograft deployment in infrarenal aorta is a possible solution.
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Affiliation(s)
- Anna Giulia Carli
- Vascular Surgery, Department of Medicine and Surgery, University of Parma Parma, Italy.
| | - Paolo Perini
- Vascular Surgery, Department of Medicine and Surgery, University of Parma Parma, Italy
| | - Luigi Vignali
- Interventional Cardiology, University Hospital of Parma, Parma, Italy
| | | | - Mara Fanelli
- Vascular Surgery, Department of Medicine and Surgery, University of Parma Parma, Italy
| | - Antonio Freyrie
- Vascular Surgery, Department of Medicine and Surgery, University of Parma Parma, Italy
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16
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Lee EM, Yun G, Kazerooni EA, Shah PN, Deeb M, Agarwal PP. Case-based Review of Migrated Devices Seen at Cardiothoracic Imaging. Radiographics 2021; 41:56-57. [PMID: 33411610 DOI: 10.1148/rg.2021200116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth M Lee
- From the Department of Radiology, Cardiothoracic Division (E.M.L., G.Y., E.A.K., P.P.A.) and Department of Cardiac Surgery (M.D.), Michigan Medicine, 1500 E Medical Center Dr, SPC 5030, University Hospital Floor B1 Reception C, Ann Arbor, MI 48109; and Department of Radiology, Rush University Medical Center, Chicago, Ill (P.N.S.)
| | - Gabin Yun
- From the Department of Radiology, Cardiothoracic Division (E.M.L., G.Y., E.A.K., P.P.A.) and Department of Cardiac Surgery (M.D.), Michigan Medicine, 1500 E Medical Center Dr, SPC 5030, University Hospital Floor B1 Reception C, Ann Arbor, MI 48109; and Department of Radiology, Rush University Medical Center, Chicago, Ill (P.N.S.)
| | - Ella A Kazerooni
- From the Department of Radiology, Cardiothoracic Division (E.M.L., G.Y., E.A.K., P.P.A.) and Department of Cardiac Surgery (M.D.), Michigan Medicine, 1500 E Medical Center Dr, SPC 5030, University Hospital Floor B1 Reception C, Ann Arbor, MI 48109; and Department of Radiology, Rush University Medical Center, Chicago, Ill (P.N.S.)
| | - Palmi N Shah
- From the Department of Radiology, Cardiothoracic Division (E.M.L., G.Y., E.A.K., P.P.A.) and Department of Cardiac Surgery (M.D.), Michigan Medicine, 1500 E Medical Center Dr, SPC 5030, University Hospital Floor B1 Reception C, Ann Arbor, MI 48109; and Department of Radiology, Rush University Medical Center, Chicago, Ill (P.N.S.)
| | - Michael Deeb
- From the Department of Radiology, Cardiothoracic Division (E.M.L., G.Y., E.A.K., P.P.A.) and Department of Cardiac Surgery (M.D.), Michigan Medicine, 1500 E Medical Center Dr, SPC 5030, University Hospital Floor B1 Reception C, Ann Arbor, MI 48109; and Department of Radiology, Rush University Medical Center, Chicago, Ill (P.N.S.)
| | - Prachi P Agarwal
- From the Department of Radiology, Cardiothoracic Division (E.M.L., G.Y., E.A.K., P.P.A.) and Department of Cardiac Surgery (M.D.), Michigan Medicine, 1500 E Medical Center Dr, SPC 5030, University Hospital Floor B1 Reception C, Ann Arbor, MI 48109; and Department of Radiology, Rush University Medical Center, Chicago, Ill (P.N.S.)
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17
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Tamadon I, Mamone V, Huan Y, Condino S, Quaglia C, Ferrari V, Ferrari M, Menciassi A. ValveTech: A Novel Robotic Approach for Minimally Invasive Aortic Valve Replacement. IEEE Trans Biomed Eng 2020; 68:1238-1249. [PMID: 32931426 DOI: 10.1109/tbme.2020.3024184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Aortic valve disease is the most common heart disease in the elderly calling for replacement with an artificial valve. The presented surgical robot aims to provide a highly controllable instrument for efficient delivery of an artificial valve by the help of integrated endoscopic vision. METHODS A robot (called ValveTech), intended for minimally invasive surgery (MIS) and consisting of a flexible cable driven manipulator, a passive arm, and a control unit has been designed and prototyped. The flexible manipulator has several features (e.g., stabilizing flaps, tiny cameras, dexterous introducer and custom cartridge) to help the proper valve placement. It provides 5 degrees of freedom for reaching the operative site via mini-thoracotomy; it adjusts the valve and expands it at the optimal position. The robot was evaluated by ten cardiac surgeons following a real surgical scenario in artificial chest simulator with an aortic mockup. Moreover, after each delivery, the expanded valve was evaluated objectively in comparison with the ideal position. RESULTS The robot performances were evaluated positively by surgeons. The trials resulted in faster delivery and an average misalignment distance of 3.8 mm along the aorta axis; 16.3 degrees rotational angle around aorta axis and 8.8 degrees misalignment of the valve commissure plane to the ideal plane were measured. CONCLUSION The trials successfully proved the proposed system for valve delivery under endoscopic vision. SIGNIFICANCE The ValveTech robot can be an alternative solution for minimally invasive aortic valve surgery and improve the quality of the operation both for surgeons and patients.
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18
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Jones BM, Jobanputra Y, Krishnaswamy A, Mick S, Bhargava M, Wilkoff BL, Kapadia SR. Rapid ventricular pacing during transcatheter valve procedures using an internal device and programmer: A demonstration of feasibility. Catheter Cardiovasc Interv 2020; 95:1042-1048. [PMID: 31429191 DOI: 10.1002/ccd.28450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/01/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To develop a protocol for using a pre-existing, permanent pacemaker or defibrillator device for rapid ventricular pacing during transcatheter valve procedures and demonstrate feasibility. BACKGROUND Placement of a passive fixation, temporary pacemaker wire is considered routine during most transcatheter valve procedures to facilitate controlled or rapid ventricular pacing at the time of balloon expansion or valve deployment. Many patients presenting for such procedures have a pre-existing, permanent pacemaker or defibrillator device which could be used for the same function, obviating the need for temporary pacemaker wire placement. METHODS We developed a strategy for rapid pacing from the pre-existing device using a programmer during transcatheter valve procedures in consecutive patients over a 3-month period. Complications and clinical outcomes were recorded. RESULTS There were 135 transcatheter valve procedures performed during the study. Of these, 28 (20.7%) had pre-existing devices (17 transcatheter aortic valve replacement, 3 aortic valve-in-valve, 2 mitral valve-in-valve, and 6 balloon aortic valvuloplasty). All patients underwent rapid ventricular pacing using a commercially available device programmer. There were no adverse events related to device pacing and no patients required placement of a temporary pacemaker wire during the procedure. At 30-days follow-up, there were no deaths, one major vascular complication related to arterial access, and one patient with renal failure requiring dialysis. CONCLUSION Pacing from a commercially available device programmer is safe, feasible, and may reduce both procedural cost and complications such as cardiac tamponade by avoiding placement of a temporary pacemaker lead during transcatheter valve procedures.
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Affiliation(s)
- Brandon M Jones
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Yash Jobanputra
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Stephanie Mick
- Department of Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Mandeep Bhargava
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bruce L Wilkoff
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
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19
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Nazif TM, Chen S, Codner P, Grossman PM, Menees DS, Sanchez CE, Yakubov SJ, White J, Kapadia S, Whisenant BK, Forrest JK, Krishnaswamy A, Arshi A, Orford JL, Leon MB, Dizon JM, Kodali SK, Chetcuti SJ. The initial U.S. experience with the Tempo active fixation temporary pacing lead in structural heart interventions. Catheter Cardiovasc Interv 2020; 95:1051-1056. [PMID: 31478304 DOI: 10.1002/ccd.28476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/30/2019] [Accepted: 08/12/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This multicenter retrospective study of the initial U.S. experience evaluated the safety and efficacy of temporary cardiac pacing with the Tempo® Temporary Pacing Lead. BACKGROUND Despite increasing use of temporary cardiac pacing with the rapid growth of structural heart procedures, temporary pacing leads have not significantly improved. The Tempo lead is a new temporary pacing lead with a soft tip intended to minimize the risk of perforation and a novel active fixation mechanism designed to enhance lead stability. METHODS Data from 269 consecutive structural heart procedures were collected. Outcomes included device safety (absence of clinically significant cardiac perforation, new pericardial effusion, or sustained ventricular arrhythmia) and efficacy (clinically acceptable pacing thresholds with successful pace capture throughout the index procedure). Postprocedure practices and sustained lead performance were also analyzed. RESULTS The Tempo lead was successfully positioned in the right ventricle and achieved pacing in 264 of 269 patients (98.1%). Two patients (0.8%) experienced loss of pace capture. Procedural mean pace capture threshold (PCT) was 0.7 ± 0.8 mA. There were no clinically significant perforations, pericardial effusions, or sustained device-related arrhythmias. The Tempo lead was left in place postprocedure in 189 patients (71.6%) for mean duration of 43.3 ± 0.7 hr (range 2.5-221.3 hr) with final PCT of 0.84 ± 1.04 mA (n = 80). Of these patients, 84.1% mobilized out of bed with no lead dislodgment. CONCLUSION The Tempo lead is safe and effective for temporary cardiac pacing for structural heart procedures, provides stable peri and postprocedural pacing and allows mobilization of patients who require temporary pacing leads.
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Affiliation(s)
- Tamim M Nazif
- Columbia University Irving Medical Center, New York, New York.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Shmuel Chen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Pablo Codner
- Columbia University Irving Medical Center, New York, New York
| | - Paul M Grossman
- University of Michigan Cardiovascular Center, Ann Arbor, Michigan
| | - Daniel S Menees
- University of Michigan Cardiovascular Center, Ann Arbor, Michigan
| | | | | | - Jonathan White
- Cleveland Clinic Heart & Vascular Institute, Cleveland, Ohio
| | - Samir Kapadia
- Cleveland Clinic Heart & Vascular Institute, Cleveland, Ohio
| | | | - John K Forrest
- Yale University School of Medicine, New Haven, Connecticut
| | | | - Arash Arshi
- OhioHealth/Riverside Methodist Hospital, Columbus, Ohio
| | - James L Orford
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - José M Dizon
- Columbia University Irving Medical Center, New York, New York
| | - Susheel K Kodali
- Columbia University Irving Medical Center, New York, New York.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
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20
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Naik M, McNamara C, Jabbour RJ, Gopalan D, Mikhail GW, Mirsadraee S, Ariff B. Imaging of transcatheter aortic valve replacement complications. Clin Radiol 2020; 76:27-37. [PMID: 31964536 DOI: 10.1016/j.crad.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/11/2019] [Indexed: 01/05/2023]
Abstract
Aortic stenosis is increasing in incidence and is now commonly managed with transcatheter aortic valve replacement (TAVR) in intermediate and high-risk patients. Radiologists are likely to encounter patients undergoing this procedure both pre- and postoperatively, and therefore, an understanding of procedural complications is essential. Complications may relate to the access site or approach, or the valve itself. This article will review the most common complications described in literature and focuses on the role of multidetector computed tomography (CT) in their evaluation either exclusively, or complementary to other imaging methods.
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Affiliation(s)
- M Naik
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - C McNamara
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - R J Jabbour
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - D Gopalan
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - G W Mikhail
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - S Mirsadraee
- Department of Radiology, Harefield Hospital, Hill End Road, Uxbridge, UB9 6JH, UK
| | - B Ariff
- Department of Radiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.
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21
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Rescate transapical mediante pinzas de laparoscopia de prótesis aórtica embolizada. CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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22
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Goel S, Cordeiro N, Frankel R. Valve-in-Valve for CoreValve Pop Out. JACC Cardiovasc Interv 2019; 12:2225-2226. [PMID: 31377273 DOI: 10.1016/j.jcin.2019.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/30/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Sunny Goel
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York.
| | - Nikhil Cordeiro
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York
| | - Robert Frankel
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York
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23
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Kim WK, Schäfer U, Tchetche D, Nef H, Arnold M, Avanzas P, Rudolph T, Scholtz S, Barbanti M, Kempfert J, Mangieri A, Lauten A, Frerker C, Yoon SH, Holzamer A, Praz F, De Backer O, Toggweiler S, Blumenstein J, Purita P, Tarantini G, Thilo C, Wolf A, Husser O, Pellegrini C, Burgdorf C, Antolin RAH, Díaz VAJ, Liebetrau C, Schofer N, Möllmann H, Eggebrecht H, Sondergaard L, Walther T, Pilgrim T, Hilker M, Makkar R, Unbehaun A, Börgermann J, Moris C, Achenbach S, Dörr O, Brochado B, Conradi L, Hamm CW. Incidence and outcome of peri-procedural transcatheter heart valve embolization and migration: the TRAVEL registry (TranscatheteR HeArt Valve EmboLization and Migration). Eur Heart J 2019; 40:3156-3165. [DOI: 10.1093/eurheartj/ehz429] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/09/2019] [Accepted: 05/30/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Peri-procedural transcatheter valve embolization and migration (TVEM) is a rare but potentially devastating complication of transcatheter aortic valve implantation (TAVI). We sought to assess the incidence, causes, and outcome of TVEM in a large multicentre cohort.
Methods and results
We recorded cases of peri-procedural TVEM in patients undergoing TAVI between January 2010 and December 2017 from 26 international sites. Peri-procedural TVEM occurred in 273/29 636 (0.92%) TAVI cases (age 80.8 ± 7.3 years; 53.8% female), of which 217 were to the ascending aorta and 56 to the left ventricle. The use of self-expanding or first-generation prostheses and presence of a bicuspid aortic valve were independent predictors of TVEM. Bail-out measures included repositioning attempts using snares or miscellaneous tools (41.0%), multiple valve implantations (83.2%), and conversion to surgery (19.0%). Using 1:4-propensity matching, we identified a cohort of 235 patients with TVEM (TVEMPS) and 932 patients without TVEM (non-TVEMPS). In the matched cohort, all-cause mortality was higher in TVEMPS than in non-TVEMPS at 30 days (18.6% vs. 4.9%; P < 0.001) and after 1 year (30.5% vs. 16.6%; P < 0.001). Major stroke was more frequent in TVEMPS at 30 days (10.6% vs. 2.8%; P < 0.001), but not at 1 year (4.6% vs. 1.9%; P = 0.17). The need for emergent cardiopulmonary support, major stroke at 30 days, and acute kidney injury Stages 2 and 3 increased the risk of 1-year mortality, whereas a better renal function at baseline was protective.
Conclusion
Transcatheter valve embolization and migration occurred in approximately 1% and was associated with increased morbidity and mortality.
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Affiliation(s)
- Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Frankfurt am Main, Germany
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
- Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
| | - Ulrich Schäfer
- Department of General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf (UKE), Germany
| | - Didier Tchetche
- Groupe Cardiovasculaire Interventionel (GCVI), Clinique Pasteur, Toulouse, France
| | - Holger Nef
- Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
| | - Martin Arnold
- Department of Cardiology, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Pablo Avanzas
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Department of Medicine, University of Oviedo, Oviedo, Spain
| | - Tanja Rudolph
- Department of Cardiology, University of Cologne, Heart Center, Cologne, Germany
| | - Smita Scholtz
- Department of Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
- Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Alexander Lauten
- Department of Cardiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Christian Frerker
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Sung-Han Yoon
- Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Andreas Holzamer
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
| | - Fabien Praz
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Ole De Backer
- The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Paola Purita
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | - Alexander Wolf
- Department of Cardiology and Angiology, Elisabeth-Hospital Essen, Germany
| | - Oliver Husser
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Costanza Pellegrini
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Christof Burgdorf
- Department of Cardiology, Heart and Vascular Center Bad Bevensen, Bad Bevensen, Germany
| | | | - Victor A Jiménez Díaz
- Hospital Alvaro Cunqueiro, Interventional Cardiology Unit, Department of Cardiology, University Hospital of Vigo, Vigo, Spain
| | - Christoph Liebetrau
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Frankfurt am Main, Germany
- Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
| | - Niklas Schofer
- Department of General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf (UKE), Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Holger Eggebrecht
- Department of Cardiology, Cardioangiologisches Centrum Bethanien (CCB) at the AGAPLESION Bethanien Hospital, Frankfurt, Germany
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Thomas Pilgrim
- The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Michael Hilker
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Raj Makkar
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
| | - Axel Unbehaun
- EMO-GVM Centro Cuore and San Raffaele Hospitals, Milan, Italy
| | - Jochen Börgermann
- Herz- und Diabeteszentrum NRW, Department of Cardiovascular Surgery, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Cesar Moris
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Department of Medicine, University of Oviedo, Oviedo, Spain
| | - Stephan Achenbach
- Department of Cardiology, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Dörr
- Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
| | - Bruno Brochado
- Groupe Cardiovasculaire Interventionel (GCVI), Clinique Pasteur, Toulouse, France
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center, University Hospital Hamburg-Eppendorf (UKE), Germany
| | - Christian W Hamm
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Frankfurt am Main, Germany
- Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
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24
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Khan A, Dangas G. Positioning of self-expanding transcatheter valve prostheses. Catheter Cardiovasc Interv 2019; 93:530-531. [PMID: 30770668 DOI: 10.1002/ccd.28134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 11/08/2022]
Abstract
The anatomic interplay between aortic valve, ascending aorta, left ventricular outflow tract and peripheral vasculature play a major role in determining device related outcomes in transcatheter aortic valve replacement. Factors such as the alignment angle (prosthesis-ascending aorta), pre-dilatation, operating team experience and chronic kidney disease may play a role in valve displacement. Careful analysis of all imaging modalities while sizing and selecting a valve type, and attention to newer deployment techniques may improve outcomes.
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Affiliation(s)
- Asaad Khan
- Icahn School of Medicine at Mount Sinai, Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - George Dangas
- Icahn School of Medicine at Mount Sinai, Cardiovascular Institute, Mount Sinai Hospital, New York, New York
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25
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Hachinohe D, Latib A, Laricchia A, Demir OM, Agricola E, Romano V, Del Sole PA, Leone PP, Ancona MB, Mangieri A, Regazzoli D, Giannini F, Mitomo S, Monaco F, Buzzatti N, Montorfano M, Colombo A. Anatomic and procedural associations of transcatheter heart valve displacement following Evolut R implantation. Catheter Cardiovasc Interv 2018; 93:522-529. [PMID: 30286515 DOI: 10.1002/ccd.27827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study aimed to predict the displacement of self-expanding transcatheter heart valves (THV) during final deployment. BACKGROUND Accurate device positioning during transcatheter aortic valve implantation (TAVI) is crucial for optimal results. METHODS At our institution, 103 patients who underwent transfemoral TAVI with Evolut R were retrospectively identified. Multiple linear regression models were created, and a predictor equation was built to quantify the factors that may affect THV behavior. RESULTS Multiple linear regression analysis for THV displacement on the left coronary cusp (LCC) identified the angle between the THV and the ascending aorta (ATA), predilation, and less operator experience as independent predictors of upward displacement, whereas estimated glomerular filtration rate (eGFR) was inversely related with THV behavior (95% confidence interval: 0.219 to 0.340, 0.447 to 2.092, 0.165 to 1.757, and -0.053 to -0.011, respectively). Predictors of THV displacement on the noncoronary cusp side could not be identified using this model. CONCLUSIONS The ATA at the point of recapture, predilation, and less operator experience were independent predictors of upward displacement of THV on the LCC side. eGFR was an independent predictor of THV downward displacement on the LCC side. Of them, the ATA was the strongest predictor. Physicians may need to adjust this angle adequately before deployment to achieve the appropriate position.
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Affiliation(s)
- Daisuke Hachinohe
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Department of Cardiology, Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Division of Cardiology, University of Cape Town, Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Ozan M Demir
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Department of Cardiology, Hammersmith Hospital, Imperial College Hospital Healthcare NHS Trust, London, United Kingdom
| | - Eustachio Agricola
- Non-invasive Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Romano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Pier Pasquale Leone
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Regazzoli
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Satoru Mitomo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Fabrizio Monaco
- Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Cardiac Surgery Unit, Cardiology and Cardiothoracic Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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26
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Late migration of Edwards SAPIEN 3 transcatheter heart valves: mechanisms and transcatheter treatment options for a rare phenomenon. Clin Res Cardiol 2018; 107:1183-1186. [DOI: 10.1007/s00392-018-1301-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 06/11/2018] [Indexed: 10/14/2022]
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Clinical outcomes of coronary occlusion following transcatheter aortic valve replacement: A systematic review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:229-236. [DOI: 10.1016/j.carrev.2017.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/07/2017] [Accepted: 09/07/2017] [Indexed: 12/20/2022]
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Duque Santos Á, Reyes Valdivia A, Gallo González P, González Ferrer E, Ocaña Guaita J, Gandarias Zúñiga C. Descending Aorta Rupture after Transcatheter Aortic Valve Embolization. Ann Vasc Surg 2018; 49:312.e1-312.e4. [PMID: 29455016 DOI: 10.1016/j.avsg.2017.11.042] [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: 06/12/2017] [Revised: 09/30/2017] [Accepted: 11/02/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND To report a case of rupture of the descending aorta after aortic migration during transcatheter aortic valve replacement (TAVR). METHODS An 85-year-old man with a severe and symptomatic aortic stenosis underwent elective TAVR, which complicated with embolization into the ascending aorta. While repositioning into the descending aorta, the procedure complicated with aortic rupture. RESULTS The patient required urgent thoracic intravalve stent-graft implantation (thoracic endovascular aortic repair [TEVAR]). Reintervention with other stent graft was required 2 days after initial procedure as proximal rupture was again diagnosed. Patient was discharged 50 days later because of other medical complications. He remains stable at 1 year of follow-up. CONCLUSIONS TEVAR is a valid and safe option in the treatment of iatrogenic acute aortic rupture due to TAVR.
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Affiliation(s)
- África Duque Santos
- Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain.
| | - Andrés Reyes Valdivia
- Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain
| | - Pablo Gallo González
- Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain
| | | | - Julia Ocaña Guaita
- Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain
| | - Claudio Gandarias Zúñiga
- Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain
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Ito M, Tada N, Hata M. Balloon Repositioning of Transcatheter Aortic Valve after Migration into the Left Ventricular Outflow Tract, Followed by Valve-in-Valve Procedure. Tex Heart Inst J 2017; 44:274-278. [PMID: 28878583 DOI: 10.14503/thij-16-5958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Transcatheter aortic valve replacement is an established option for treating patients with symptomatic aortic stenosis; however, severe, life-threatening complications, such as valve migration, are possible. We report the case of an 82-year-old woman whose Edwards Sapien XT valve migrated into the left ventricular outflow tract one day after transcatheter aortic valve replacement. We used an inflated balloon to adjust the position of the migrated valve before performing a valve-in-valve procedure via a transapical approach, which resulted in a good valve implantation.
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Off-Pump Transapical Removal of an Embolized Transcatheter Aortic Valve. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:221-223. [PMID: 28549025 DOI: 10.1097/imi.0000000000000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transcatheter aortic valve replacement is a less invasive alternative for high-risk patients. However, valve embolization is a rare but dreaded complication. We report the successful off-pump retrieval of an embolized valve after transfemoral transcatheter aortic valve replacement through a left anterior thoracotomy. We maintained the embolized valve on the guidewire and snared it using a transapical approach. We then deployed a valve in an adequate position to ensure hemodynamic stability before transapical removal of the embolized valve. Transapical exteriorization of the femoral guidewire offers additional support, particularly in patients with a horizontal aortic annulus.
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Taylor LJ, Raval AN, Osaki S, Kohmoto T, Lozonschi L. Off-Pump Transapical Removal of An Embolized Transcatheter Aortic Valve. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lauren J. Taylor
- Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, WI USA
| | - Amish N. Raval
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison, WI USA
| | - Satoru Osaki
- Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin, Madison, WI USA
| | - Takushi Kohmoto
- Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin, Madison, WI USA
| | - Lucian Lozonschi
- Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin, Madison, WI USA
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Hachinohe D, Kobayashi K, Furugen A, Koshima R. Left Ventricular Outflow Tract Migration of a Balloon-Expandable Prosthesis During Transcatheter Aortic Valve Implantation. Int Heart J 2017; 58:290-293. [PMID: 28321026 DOI: 10.1536/ihj.16-288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Valve migration into the left ventricular outflow tract (LVOT) during transcatheter aortic valve implantation (TAVI) is a life-threatening complication. An 89-year-old female patient was admitted for TAVI due to severe symptomatic aortic stenosis. After deployment of a balloon-expandable prosthesis, the prosthesis had migrated into the LVOT. The prosthesis was reimpacted to the aortic annulus by a balloon-assisted recapture procedure. Immediately after recapturing the prosthesis with an oversized balloon, the patient's vital signs deteriorated due to acute aortic regurgitation (AR), and a prompt valve-in-valve (V-in-V) procedure allowed us to stabilize the patient's condition. This is the first reported case of a V-in-V procedure using an oversized balloon and a larger prosthesis to treat migration of the initial prosthesis into the LVOT. Balloon recapture and V-in-V procedure using an oversized balloon and larger prosthesis for a migrated balloonexpandable prosthesis into the LVOT is feasible, but hemodynamic support should be prepared before recapture and Vin-V because overdilatation of the first prosthesis might cause hemodynamic collapse due to severe AR.
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Fryearson J, Edwards NC, Doshi SN, Steeds RP. The role of TTE in assessment of the patient before and following TAVI for AS. Echo Res Pract 2016; 3:R19-34. [PMID: 27249549 PMCID: PMC4989100 DOI: 10.1530/erp-16-0004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/13/2016] [Indexed: 12/12/2022] Open
Abstract
Transcatheter aortic valve implantation is now accepted as a standard mode of treatment for an increasingly large population of patients with severe aortic stenosis. With the availability of this technique, echocardiographers need to be familiar with the imaging characteristics that can help to identify which patients are best suited to conventional surgery or transcatheter aortic valve implantation, and what parameters need to be measured. This review highlights the major features that should be assessed during transthoracic echocardiography before presentation of the patient to the 'Heart Team'. In addition, this review summarises the aspects to be considered on echocardiography during follow-up assessment after successful implantation of a transcatheter aortic valve.
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Affiliation(s)
- John Fryearson
- University Hospital Birmingham NHS Foundation Trust & Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham
| | - Nicola C Edwards
- University Hospital Birmingham NHS Foundation Trust & Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham
| | - Sagar N Doshi
- University Hospital Birmingham NHS Foundation Trust & Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham
| | - Richard P Steeds
- University Hospital Birmingham NHS Foundation Trust & Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham
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