Fracturing a dysfunctional Edwards Perimount bioprosthetic valve to facilitate percutaneous valve-in-valve placement of SAPIEN 3 valve with modified delivery system

2017 ◽  
Vol 91 (1) ◽  
pp. 81-85 ◽  
Author(s):  
Shabana Shahanavaz ◽  
Toby Rockefeller ◽  
Ramzi Nicolas ◽  
David Balzer
Keyword(s):  
Delivery System ◽  
Bioprosthetic Valve ◽  
Valve In Valve ◽  
Valve Placement ◽  
Sapien 3 ◽  
Percutaneous Valve

Successful use of 20mm SAPIEN 3 for valve-in-valve intervention within a 19mm degenerated aortic bioprosthetic valve

2016 ◽  
Vol 203 ◽  
pp. 156-157 ◽  
Author(s):  
Arun K. Thukkani ◽  
Michael R. Klein ◽  
Michael Mauney ◽  
Nicholas Kouchoukos ◽  
Joshua N. Baker
Keyword(s):  
Bioprosthetic Valve ◽  
Valve In Valve ◽  
Sapien 3

scholarly journals Valve-in-valve transcatheter aortic valve implantation with fracturing of a failed small surgical aortic bioprosthesis: a case report

2020 ◽  
Author(s):  
Matjaz Bunc ◽  
Miha Cercek ◽  
Tomaz Podlesnikar ◽  
Simon Terseglav ◽  
Klemen Steblovnik
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Ex Vivo ◽  
Bioprosthetic Valve ◽  
Heart Team ◽  
Transcatheter Aortic Valve ◽  
Patient Prosthesis Mismatch ◽  
Valve In Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Failure of a small surgical aortic bioprosthesis represents a challenging clinical scenario with valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) often resulting in patient-prosthesis mismatch. Bioprosthetic valve fracture (BVF) performed as a part of the ViV TAVI has recently emerged as an alternative approach with certain types of surgical bioprostheses. Case summary An 81-year-old woman with a history of three surgical aortic valve procedures presented with heart failure. Aortic bioprosthesis degeneration with severe stenosis and moderate regurgitation was found. The patient was deemed a high-risk surgical candidate and the heart team decided that ViV TAVI was the preferred treatment option. Due to the very small 19 mm stented surgical aortic bioprosthesis Mitroflow 19 mm (Sorin Group, Italy) we decided to perform BVF as a part of ViV TAVI to prevent patient-prosthesis mismatch. Since this was the first BVF procedure in our centre, an ex vivo BVF of the same kind of bioprosthetic valve was performed first. Subsequently, successful BVF with implantation of Evolut R 23 mm (Medtronic, USA) self-expandable transcatheter valve was performed. Excellent haemodynamic result was achieved and no periprocedural complications were present. The patient had an immediate major improvement in clinical status and remains asymptomatic after 6 months. Discussion Bioprosthetic valve fracture together with ViV TAVI is a safe and effective emerging technique for treatment of small surgical aortic bioprosthesis failure. Bioprosthetic valve fracture allows marked oversizing of implanted self-expandable transcatheter aortic valves, leading to excellent haemodynamic and clinical results. An ex vivo BVF can serve as an important preparatory step when introducing the new method.

Pre-existent 1st degree AV-Block before TAVI with Sapien 3 – is prolonged monitoring required?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F De Torres Alba ◽  
G Kaleschke ◽  
J Vormbrock ◽  
H Reinecke ◽  
H Deschka ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
High Grade ◽  
Av Block ◽  
Multivariable Logistic Regression Model ◽  
Consensus Document ◽  
Risk Patients ◽  
Valve In Valve ◽  
Prolonged Monitoring ◽  
Sapien 3 ◽  
Expert Consensus Document

Abstract Introduction Pre-existing right bundle branch block (RBBB) is a well stablished risk factor for the development of high grade conduction abnormalities (CAs) after TAVI. The association of pre-existing 1st degree AV-Block (AVB1) with high grade CAs after TAVI has been inconsistent. A recently published Expert Consensus Document classifies patients with AVB1 in the lowest risk group, allowing for discharge at day 1 post-TAVI. We aimed to study the risk of these patients of developing delayed high grade CAs requiring pacemaker implantation (PM). Methods We studied the development CAs in 1447 consecutive patients treated with Sapien 3 between January 2014 and December 2019. After excluding valve-in-valve procedures (n=30) and pts with previously implanted PM (n=167) 1254 patients remained for analysis. All patients were monitored for at least 7 days, as this was our institutional policy during the study period. We analyzed if pre-existing ECG abnormalities predict early and delayed (>24h) high grade CAs with a multivariable logistic regression model. Results Of 1254 pts, 159 (12.5%) required a permanent PM after TAVI. In 104 (65%) CAs requiring PM occurred intraprocedural or during the first 48h while in the remaining 35% developed with more delay. We analyzed the presence of previous CAs in pts still free from indication for PM after the first 48h after TAVI (n=1150) in order to identify characteristics that may predict delayed PM requirement (Table). In the multivariable model not only RBBB (OR 5.42, CI95% 2.69–10.94, p<0.0001) but also AVB1 was significantly associated to delayed high grade CAs requiring PM implantation (OR 2.25, CI95% 1.24–4.08, p=0.005). Conclusion In this study, in pts requiring PM implantation after TAVI, the high grade CAs occurred after 48h in 35% of patients. Not only RBBB but also AVB1 was an independent predictor of delayed high grade CAs. These results question the safety of considering patients with pre-existing AVB1 as low-risk patients and suggest a more prolonged monitoring also for them. Funding Acknowledgement Type of funding source: None

Transapical Transcatheter Mitral Valve-in-Valve Implantation Using an Edwards SAPIEN 3 Valve

2017 ◽  
Vol 26 (4) ◽  
pp. e19-e21 ◽  
Author(s):  
Cheng He ◽  
Gregory Scalia ◽  
Darren L. Walters ◽  
Andrew Clarke
Keyword(s):  
Mitral Valve ◽  
Edwards Sapien ◽  
Valve In Valve ◽  
Sapien 3 ◽  
Valve Implantation

scholarly journals Numerical models for assessing the risk of leaflet thrombosis post-transcatheter aortic valve-in-valve implantation

2020 ◽  
Vol 7 (12) ◽  
pp. 201838
Author(s):  
Romina Plitman Mayo ◽  
Halit Yaakobovich ◽  
Ariel Finkelstein ◽  
Shawn C. Shadden ◽  
Gil Marom
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Numerical Models ◽  
Aortic Valves ◽  
Transcatheter Aortic Valve ◽  
Edwards Sapien ◽  
Valve In Valve ◽  
Sapien 3 ◽  
Valve Implantation ◽  
Numerical Approaches

Leaflet thrombosis has been suggested as the reason for the reduced leaflet motion in cases of hypoattenuated leaflet thickening of bioprosthetic aortic valves. This work aimed to estimate the risk of leaflet thrombosis in two post-valve-in-valve (ViV) configurations, using five different numerical approaches. Realistic ViV configurations were calculated by modelling the deployments of the latest version of transcatheter aortic valve devices (Medtronic Evolut PRO, Edwards SAPIEN 3) in the surgical Sorin Mitroflow. Computational fluid dynamics simulations of blood flow followed the dry models. Lagrangian and Eulerian measures of near-wall stagnation were implemented by particle and concentration tracking, respectively, to estimate the thrombogenicity and to predict the risk locations. Most of the numerical approaches indicate a higher leaflet thrombosis risk in the Edwards SAPIEN 3 device because of its intra-annular implantation. The Eulerian approaches estimated high-risk locations in agreement with the wall sheer stress (WSS) separation points. On the other hand, the Lagrangian approaches predicted high-risk locations at the proximal regions of the leaflets matching the low WSS magnitude regions of both transcatheter aortic valve implantation models and reported clinical and experimental data. The proposed methods can help optimizing future designs of transcatheter aortic valves with minimal thrombotic risks.

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