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Case Reports
. 2024 Mar 11;8(3):ytae126.
doi: 10.1093/ehjcr/ytae126. eCollection 2024 Mar.

Transcatheter aortic valve implantation for structural valve deterioration of homograft surgical aortic valve using SAPIEN3 Ultra RESILIA: a case report

Kazuki Mizutani  1 , Masafumi Ueno  1 , Genichi Sakaguchi  2 , Gaku Nakazawa  1
Affiliations
Case Reports

Transcatheter aortic valve implantation for structural valve deterioration of homograft surgical aortic valve using SAPIEN3 Ultra RESILIA: a case report

Kazuki Mizutani et al. Eur Heart J Case Rep. .

Abstract

Background: There are a few case reports regarding transcatheter aortic valve implantation (TAVI) for deteriorated surgical homograft.

Case summary: We present a case of severe structural valve deterioration (SVD) of homograft surgical aortic valve presenting severe aortic regurgitation in an 84-year-old man with decompensated heart failure. We performed TAVI in homograft valve using 23 mm SAPIEN3 Ultra RESILIA. The resulting grade of paravalvular regurgitation was trace, the post-operative effective orifice area (EOA) was 1.66 cm2 (index EOA: 1.19 cm2/m2), and device success was achieved.

Discussion: Stented bioprosthetic valves are more commonly implanted than mechanical and stentless bioprosthetic valves. In the 1980s and the early 1990s, homografts became particularly popular as alternatives to stented valves. There are several reports of TAVI for homograft SVD, but the paravalvular leakage grade is worse than that of redo-surgical aortic valve replacement, although the mortality rate is lower. However, the valves used in these reports were from older valves such as SAPIEN XT or SAPIEN3. There are no reports using SAPIEN3 Ultra RESILIA with a significant reduction in paravalvular leak due to an external textured polyethylene terephthalate skirt extending 40% higher above the valve inflow than the classical SAPIEN3, which is now available. Transcatheter aortic valve implantation using SAPIEN3 Ultra RESILIA showed good therapeutic efficacy.

Keywords: Aortic regurgitation; Aortic stenosis; Case report; Homograft; Structural valve deterioration; Transcatheter aortic valve replacement.

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Conflict of interest statement

Conflict of interest: K.M. is a clinical TAVI proctor of Edwards Lifesciences and Medtronic.

Figures

Figure 1
Figure 1
Periprocedural echocardiography. (A) Aortic valve assessment using continuous wave Doppler before TAVI. (B) AR grade before TAVI. (C) Aortic valve assessment using continuous wave Doppler after TAVI. (D) AR grade after TAVI. AR, aortic regurgitation; LA, left atrium; LV, left ventricle; TAVI, transcatheter aortic valve implantation.
Figure 2
Figure 2
Pre-procedural computed tomography. (A) Annulus level, (B) 4 mm above the annulus, (C) sinus of Valsalva, and (D) 3D constructed aortic image. Blue arrows show the calcification of anastomosis. Yellow arrows show leaflet calcification. D, dimension.
Figure 3
Figure 3
TAVI with 23 mm SAPIEN3 Ultra RESILIA. (A) Aortogram before TAVI. (B) Aortogram after TAVI. Ao, aorta; LV, left ventricle; TAVI, transcatheter aortic valve implantation.
None
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