Valve-in-valve implantation of a novel and small self-expandable transcatheter heart valve in degenerated small surgical bioprostheses: the Hamburg experience
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Valve-in-valve implantation of a novel and small self-expandable transcatheter heart valve in degenerated small surgical bioprostheses: the Hamburg experience. / Diemert, Patrick; Seiffert, Moritz; Frerker, Christian; Thielsen, Thomas; Kreidel, Felix; Bader, Ralf; Schirmer, Johannes; Conradi, Lenard; Koschyk, Dietmar; Schnabel, Renate; Reichenspurner, Hermann; Blankenberg, Stefan; Kuck, Karl-Heinz; Treede, Hendrik; Schaefer, Ulrich.
in: CATHETER CARDIO INTE, Jahrgang 84, Nr. 3, 01.09.2014, S. 486-493.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Valve-in-valve implantation of a novel and small self-expandable transcatheter heart valve in degenerated small surgical bioprostheses: the Hamburg experience
AU - Diemert, Patrick
AU - Seiffert, Moritz
AU - Frerker, Christian
AU - Thielsen, Thomas
AU - Kreidel, Felix
AU - Bader, Ralf
AU - Schirmer, Johannes
AU - Conradi, Lenard
AU - Koschyk, Dietmar
AU - Schnabel, Renate
AU - Reichenspurner, Hermann
AU - Blankenberg, Stefan
AU - Kuck, Karl-Heinz
AU - Treede, Hendrik
AU - Schaefer, Ulrich
N1 - © 2013 Wiley Periodicals, Inc.
PY - 2014/9/1
Y1 - 2014/9/1
N2 - BACKGROUND: Transcatheter valve-in-valve (VIV) implantation has emerged as a novel treatment option in patients with degenerated aortic bioprostheses and high surgical risk. However, VIV implantation in small aortic bioprostheses using first generation TAVI devices has frequently resulted in high postprocedural gradients and small effective orifice areas. Recently, an updated version of the self-expandable Medtronic CoreValve prosthesis, which is particularly suitable for small aortic annuli, has become available. We report on the feasibility and early results of VIV implantation using this novel device in a series of patients with degenerated small aortic bioprostheses.METHODS AND RESULTS: 16 patients from two Hamburg hospitals (age range 72-92 years) underwent implantation of a 23-mm CoreValve Evolut (Medtronic, Minneapolis, MN, USA) transcatheter heart valve into failing aortic bioprostheses with internal diameters below 21 mm. All patients were considered high risk for surgical aortic valve replacement after evaluation by an interdisciplinary heart team mean (logistic EuroSCORE range 9.0-88%). Implantation was successful without relevant remaining aortic regurgitation or signs of stenosis and a marked reduction in postprocedural gradientswas observed in 14 out of 16 patients. The mean gradient was reduced from from 34 mm Hg (SEM 10 mm Hg) to 14 mm Hg (SEM 6 mm Hg). No major device- or procedure-related adverse events occurred during 30-day follow up and clinical improvement was observed.CONCLUSIONS: Failing aortic bioprostheses with small internal diameters continue to be a challenging pathology for TAVI due to the risk of high residual gradients and small aortic orifice areas. This report provides first evidence that the 23-mm CoreValve Evolut, a novel self-expanding prosthesis, provides an improved treatment option in these specific patients due to its low profile which resulted in promising early results. © 2013 Wiley Periodicals, Inc.
AB - BACKGROUND: Transcatheter valve-in-valve (VIV) implantation has emerged as a novel treatment option in patients with degenerated aortic bioprostheses and high surgical risk. However, VIV implantation in small aortic bioprostheses using first generation TAVI devices has frequently resulted in high postprocedural gradients and small effective orifice areas. Recently, an updated version of the self-expandable Medtronic CoreValve prosthesis, which is particularly suitable for small aortic annuli, has become available. We report on the feasibility and early results of VIV implantation using this novel device in a series of patients with degenerated small aortic bioprostheses.METHODS AND RESULTS: 16 patients from two Hamburg hospitals (age range 72-92 years) underwent implantation of a 23-mm CoreValve Evolut (Medtronic, Minneapolis, MN, USA) transcatheter heart valve into failing aortic bioprostheses with internal diameters below 21 mm. All patients were considered high risk for surgical aortic valve replacement after evaluation by an interdisciplinary heart team mean (logistic EuroSCORE range 9.0-88%). Implantation was successful without relevant remaining aortic regurgitation or signs of stenosis and a marked reduction in postprocedural gradientswas observed in 14 out of 16 patients. The mean gradient was reduced from from 34 mm Hg (SEM 10 mm Hg) to 14 mm Hg (SEM 6 mm Hg). No major device- or procedure-related adverse events occurred during 30-day follow up and clinical improvement was observed.CONCLUSIONS: Failing aortic bioprostheses with small internal diameters continue to be a challenging pathology for TAVI due to the risk of high residual gradients and small aortic orifice areas. This report provides first evidence that the 23-mm CoreValve Evolut, a novel self-expanding prosthesis, provides an improved treatment option in these specific patients due to its low profile which resulted in promising early results. © 2013 Wiley Periodicals, Inc.
KW - Aged
KW - Aged, 80 and over
KW - Aortic Valve/surgery
KW - Aortic Valve Stenosis/diagnosis
KW - Bioprosthesis/adverse effects
KW - Echocardiography
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Male
KW - Prosthesis Design
KW - Prosthesis Failure
KW - Reoperation
KW - Retrospective Studies
KW - Tomography, X-Ray Computed
KW - Transcatheter Aortic Valve Replacement/methods
KW - Treatment Outcome
U2 - 10.1002/ccd.25234
DO - 10.1002/ccd.25234
M3 - SCORING: Journal article
C2 - 24753352
VL - 84
SP - 486
EP - 493
JO - CATHETER CARDIO INTE
JF - CATHETER CARDIO INTE
SN - 1522-1946
IS - 3
ER -