Series of transcatheter valve-in-valve implantations in high-risk patients with degenerated bioprostheses in aortic and mitral position
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Series of transcatheter valve-in-valve implantations in high-risk patients with degenerated bioprostheses in aortic and mitral position. / Seiffert, Moritz; Franzen, Olaf; Conradi, Lenard; Baldus, Stephan; Schirmer, Johannes; Meinertz, Thomas; Reichenspurner, Hermann; Treede, Hendrik.
In: CATHETER CARDIO INTE, Vol. 76, No. 4, 01.10.2010, p. 608-615.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Series of transcatheter valve-in-valve implantations in high-risk patients with degenerated bioprostheses in aortic and mitral position
AU - Seiffert, Moritz
AU - Franzen, Olaf
AU - Conradi, Lenard
AU - Baldus, Stephan
AU - Schirmer, Johannes
AU - Meinertz, Thomas
AU - Reichenspurner, Hermann
AU - Treede, Hendrik
N1 - © 2010 Wiley-Liss, Inc.
PY - 2010/10/1
Y1 - 2010/10/1
N2 - OBJECTIVES: We report our experience with transcatheter valve-in-valve implantations in patients with degenerated bioprostheses in aortic and mitral position.BACKGROUND: Xenograft degeneration is a potential problem after biological valve replacement. Reoperation remains the gold standard with very good short- and long-term results. In selected patients not suitable for surgery however, interventional techniques for valve implantation and repair may be valuable alternative treatment options with regard to the good results of transcatheter valve implantation for native aortic valve stenosis.METHODS: Five patients presented with significant xenograft degeneration 15.4 ± 5.2 years after aortic (n = 4) and mitral (n = 1) valve replacement. Mean patient age was 82.0 ± 6.5 years and predicted operative mortality was 55.8% ± 18.9% (logistic EuroSCORE). Transcatheter valve-in-valve implantation was performed successfully through a transapical access in all patients. A 23-mm Edwards Sapien valve was deployed into the degenerated valve prosthesis.RESULTS: Mean transvalvular gradients were reduced from 31.2 ± 17.4 to 19.0 ± 12.4 mm Hg in aortic and from 9 to 3 mm Hg in mitral position without significant regurgitation in any of these patients. Two patients died within 30 days due to low cardiac output and acute hemorrhage, respectively, one of whom presented with a EuroSCORE of 88.9%.CONCLUSIONS: With growing need for reoperative valve replacement in elderly patients with disproportional operative risks, transcatheter valve-in-valve implantation in aortic and mitral position offers an alternative treatment option. Although valve function after transcatheter implantation was good in all patients, two high risk patients died in the postoperative period due to their significant comorbidities, underscoring the bail-out character of this procedure.
AB - OBJECTIVES: We report our experience with transcatheter valve-in-valve implantations in patients with degenerated bioprostheses in aortic and mitral position.BACKGROUND: Xenograft degeneration is a potential problem after biological valve replacement. Reoperation remains the gold standard with very good short- and long-term results. In selected patients not suitable for surgery however, interventional techniques for valve implantation and repair may be valuable alternative treatment options with regard to the good results of transcatheter valve implantation for native aortic valve stenosis.METHODS: Five patients presented with significant xenograft degeneration 15.4 ± 5.2 years after aortic (n = 4) and mitral (n = 1) valve replacement. Mean patient age was 82.0 ± 6.5 years and predicted operative mortality was 55.8% ± 18.9% (logistic EuroSCORE). Transcatheter valve-in-valve implantation was performed successfully through a transapical access in all patients. A 23-mm Edwards Sapien valve was deployed into the degenerated valve prosthesis.RESULTS: Mean transvalvular gradients were reduced from 31.2 ± 17.4 to 19.0 ± 12.4 mm Hg in aortic and from 9 to 3 mm Hg in mitral position without significant regurgitation in any of these patients. Two patients died within 30 days due to low cardiac output and acute hemorrhage, respectively, one of whom presented with a EuroSCORE of 88.9%.CONCLUSIONS: With growing need for reoperative valve replacement in elderly patients with disproportional operative risks, transcatheter valve-in-valve implantation in aortic and mitral position offers an alternative treatment option. Although valve function after transcatheter implantation was good in all patients, two high risk patients died in the postoperative period due to their significant comorbidities, underscoring the bail-out character of this procedure.
KW - Aged
KW - Aged, 80 and over
KW - Aortic Valve/diagnostic imaging
KW - Bioprosthesis
KW - Cardiac Catheterization/adverse effects
KW - Echocardiography, Doppler, Color
KW - Echocardiography, Transesophageal
KW - Female
KW - Germany
KW - Heart Valve Prosthesis
KW - Heart Valve Prosthesis Implantation/adverse effects
KW - Humans
KW - Logistic Models
KW - Male
KW - Mitral Valve/diagnostic imaging
KW - Prosthesis Design
KW - Prosthesis Failure
KW - Radiography, Interventional
KW - Risk Assessment
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1002/ccd.22618
DO - 10.1002/ccd.22618
M3 - SCORING: Journal article
C2 - 20506236
VL - 76
SP - 608
EP - 615
JO - CATHETER CARDIO INTE
JF - CATHETER CARDIO INTE
SN - 1522-1946
IS - 4
ER -
