Valve-in-valve-in-valve

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 -