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. 2016 May;31(5):282-8.
doi: 10.1111/jocs.12745. Epub 2016 Apr 5.

Valve-in-Valve Transcatheter Valve Implantation in the Nonaortic Position

David N Ranney  1 , Judson B Williams  1 , Andrew Wang  2 , Jeffrey G Gaca  1
Affiliations

Valve-in-Valve Transcatheter Valve Implantation in the Nonaortic Position

David N Ranney et al. J Card Surg. 2016 May.

Abstract

Background: Transcatheter valve-in-valve (VIV) procedures are an alternative to standard surgical valve replacement in high risk patients.

Methods: Cases in which a commercially approved transcatheter aortic valve replacement (TAVR) device was used for a nonaortic VIV procedure between November 2013 and September 2015 are reviewed. Clinical, echocardiographic, and procedural details, patient survival, and symptom severity by NYHA class at follow-up were assessed.

Results: All patients were heart-team determined high risk for conventional redo surgery (mean STS PROM = 6.8 ± 2.2%). Five patients underwent VIV replacement in the nonaortic position, four for bioprosthetic mitral valve dysfunction, and one for bioprosthetic tricuspid valve dysfunction. Bioprosthetic failure was due to stenosis in three patients and regurgitation in two others. A balloon-expandable device was used for all patients (Edwards Lifesciences, Irvine, CA, USA). Transcatheter VIV replacement was accomplished by the transapical (mitral) and transfemoral venous (tricuspid) approaches. Median postoperative length of stay was five days (range 3-12). No deaths occurred at a mean follow-up of 21 months. NYHA class at follow-up decreased from class IV at baseline to class I or II for all patients. No paravalvular leaks greater than trivial were encountered. Median mean gradient following mitral replacement was 6.5 mmHg (range 6-13 mmHg), and following tricuspid replacement was 4 mmHg. Postoperative complications included hematuria, epistaxis, acute kidney injury, and atrial fibrillation.

Conclusions: Transcatheter VIV implantation in the nonaortic position for dysfunctional bioprostheses can be performed safely with favorable clinical outcomes using a balloon expandable TAVR device. doi: 10.1111/jocs.12745 (J Card Surg 2016;31:282-288).

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Figures

Figure 1
Figure 1
Preoperative planar (left) and sagittal (right) views of the tricuspid bioprosthesis.
Figure 2
Figure 2
Transcatheter tricuspid valve implantation over pre-existing bioprosthetic valve. (a) alignment of new prosthetic inside the tricuspid orifice, (b) initial balloon expansion of the implant, (c) full balloon expansion of the implant, and (d) final positioning of the valve-in-valve implant.
Figure 3
Figure 3
Preoperative planar (left) and coronal (right) views of the mitral bioprosthetic valve.
Figure 4
Figure 4
Transcatheter mitral valve implantation over pre-existing bioprosthetic valve. (a) alignment of new prosthetic inside the mitral orifice, (b) initial balloon expansion of the implant, (c) full balloon expansion of the implant, and (d) final positioning of the valve-in-valve implant.
Figure 5
Figure 5
(a) Intra-operative TEE images prior to implantation demonstrating severe mitral regurgitation and (b) post-implantation of SAPIEN valve demonstrating trivial residual mitral regurgitation.
See this image and copyright information in PMC

References

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