Valve-in-valve-in-valve
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Valve-in-valve-in-valve : Balloon expandable transcatheter heart valve in failing self-expandable transcatheter heart valve in deteriorated surgical bioprosthesis. / Schaefer, Andreas; Deuschl, Florian; Conradi, Lenard; Schäfer, Ulrich.
in: CATHETER CARDIO INTE, Jahrgang 92, Nr. 7, 01.12.2018, S. E481-E485.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Valve-in-valve-in-valve
T2 - Balloon expandable transcatheter heart valve in failing self-expandable transcatheter heart valve in deteriorated surgical bioprosthesis
AU - Schaefer, Andreas
AU - Deuschl, Florian
AU - Conradi, Lenard
AU - Schäfer, Ulrich
N1 - © 2018 Wiley Periodicals, Inc.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Valve-in-valve (ViV) procedures for failing bioprostheses carry a certain risk for device malfunction. We herein report a case of a failing Evolut R in a deteriorated Mitroflow, treated with a Sapien 3. An 81 year old female patient received surgical aortic valve replacement and was treated by ViV due to deterioration. Three years later, echocardiography revealed a pressure gradient of peak/mean 105/63 mmHg. Subsequently, a second ViV procedure with initial intentional rupture of the bioprosthetic stent was performed. Immediate stent recoil of the Evolut R prompted implantation of a Sapien 3. In 30-day follow-up, mean pressure gradient of 30 mmHg and nearly complete symptom relief was documented. Fracture of a surgical bioprosthetic stent is feasible in a ViV configuration. Supra-annular placement of a balloon-expandable THV as ViV-in-valve is feasible with suboptimal hemodynamic results in this case. Risk of re-do surgery should be weighted against anticipated hemodynamic and clinical results.
AB - Valve-in-valve (ViV) procedures for failing bioprostheses carry a certain risk for device malfunction. We herein report a case of a failing Evolut R in a deteriorated Mitroflow, treated with a Sapien 3. An 81 year old female patient received surgical aortic valve replacement and was treated by ViV due to deterioration. Three years later, echocardiography revealed a pressure gradient of peak/mean 105/63 mmHg. Subsequently, a second ViV procedure with initial intentional rupture of the bioprosthetic stent was performed. Immediate stent recoil of the Evolut R prompted implantation of a Sapien 3. In 30-day follow-up, mean pressure gradient of 30 mmHg and nearly complete symptom relief was documented. Fracture of a surgical bioprosthetic stent is feasible in a ViV configuration. Supra-annular placement of a balloon-expandable THV as ViV-in-valve is feasible with suboptimal hemodynamic results in this case. Risk of re-do surgery should be weighted against anticipated hemodynamic and clinical results.
KW - Aged, 80 and over
KW - Aortic Valve/diagnostic imaging
KW - Aortic Valve Insufficiency/diagnostic imaging
KW - Aortic Valve Stenosis/diagnostic imaging
KW - Balloon Valvuloplasty
KW - Bioprosthesis
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Female
KW - Heart Valve Prosthesis
KW - Hemodynamics
KW - Humans
KW - Prosthesis Design
KW - Prosthesis Failure
KW - Stents
KW - Transcatheter Aortic Valve Replacement/instrumentation
KW - Treatment Outcome
U2 - 10.1002/ccd.27797
DO - 10.1002/ccd.27797
M3 - SCORING: Journal article
C2 - 30196560
VL - 92
SP - E481-E485
JO - CATHETER CARDIO INTE
JF - CATHETER CARDIO INTE
SN - 1522-1946
IS - 7
ER -