TCT-376 Bioprosthetic Valve Fracture To Improve Hemodynamic Function Following Aortic Valve-in-Valve implantation with CT follow-up

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.

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TCT-337 The Effect of Transcatheter Laceration of Degenerated Bioprosthetic Valve Leaflets on the Likelihood of leaflet thrombosis following Transcatheter Aortic Valve-in-Valve Implantation: A Computational Simulation Study

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.08.1483 ◽

2018 ◽

Vol 72 (13) ◽

pp. B137-B138

Author(s):

Farhan Khodaee ◽

Danny Dvir ◽

Ali Azadani

Keyword(s):

Aortic Valve ◽

Simulation Study ◽

Computational Simulation ◽

Bioprosthetic Valve ◽

Transcatheter Aortic Valve ◽

Valve In Valve ◽

Valve Implantation

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Transcatheter Valve-in-Valve Aortic Valve Implantation: 16-Month Follow-Up

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2009.02.053 ◽

2009 ◽

Vol 88 (4) ◽

pp. 1322-1324 ◽

Cited By ~ 24

Author(s):

Jian Ye ◽

John G. Webb ◽

Anson Cheung ◽

Jean-Bernard Masson ◽

Ronald G. Carere ◽

...

Keyword(s):

Aortic Valve ◽

Valve In Valve ◽

Aortic Valve Implantation ◽

Transcatheter Valve ◽

Valve Implantation

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Transcatheter aortic valve in valve implantation with bioprosthetic valve fracture

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.28113 ◽

2019 ◽

Vol 93 (6) ◽

pp. 1170-1172

Author(s):

Taylor M. James ◽

Sotiris C. Stamou ◽

Mark Rothenberg ◽

Marcos A. Nores

Keyword(s):

Aortic Valve ◽

Bioprosthetic Valve ◽

Transcatheter Aortic Valve ◽

Valve In Valve ◽

Valve Implantation

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First-in-Human Use of the Next-generation ProtEmbo Cerebral Embolic Protection System During Transcatheter Aortic Valve-in-valve Implantation

Interventional Cardiology Review ◽

10.15420/icr.2021.s1 ◽

2021 ◽

Vol 16 (Supplement 1) ◽

pp. 1-4

Author(s):

Dariusz Jagielak ◽

Radoslaw Targonski ◽

Dariusz Ciecwierz

Keyword(s):

Aortic Valve ◽

Aortic Arch ◽

Aortic Regurgitation ◽

Heart Valve ◽

Transcatheter Aortic Valve ◽

Transcatheter Heart Valve ◽

Valve In Valve ◽

Human Use ◽

Valve Implantation

Cerebral embolic protection (CEP) devices aim to reduce the risk of periprocedural cerebrovascular events during transcatheter aortic valve implantation (TAVI). Here, the authors describe the first-in-human experience with the ProtEmbo Cerebral Protection System (Protembis), a next-generation CEP device, during TAVI. This case is part of a larger European trial evaluating the safety and performance of this device. After deployment of the ProtEmbo in the aortic arch, a first transcatheter heart valve was implanted. Despite postdilatation, moderate to severe aortic regurgitation persisted. The operating team decided to perform a valve-in-valve procedure using a second transcatheter heart valve. The ProtEmbo demonstrated good coverage of all three head vessels and no interaction with TAVI catheters in the aortic arch throughout the entire procedure. No adverse events were observed during hospitalisation or follow-up, and there was a significant reduction in aortic regurgitation at follow-up echocardiography. Despite a challenging overall procedure with presumably high embolic burden, diffusion-weighted MRI at follow-up showed a low number (n=3) and volume (156 mm3) of new hyperintense lesions. The first-in-human use of the ProtEmbo was safe and feasible, despite a challenging TAVI valve-in-valve procedure.

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The bailout transseptal approach during valve-in-valve transcatheter aortic valve implantation with difficult crossing of the degenerated Mitroflow bioprosthetic valve

Kardiologia Polska ◽

10.33963/kp.15871 ◽

2021 ◽

Author(s):

Damian Hudziak ◽

Andrzej Ochała ◽

Radosław Gocoł ◽

Michał Kozłowski ◽

Wojciech Wojakowski

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Bioprosthetic Valve ◽

Transcatheter Aortic Valve ◽

Transseptal Approach ◽

Valve In Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

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Long term outcomes of patients with aortic structural valve deterioration treated with transcatheter valve in valve implantation

European Heart Journal ◽

10.1093/eurheartj/ehab724.1627 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

N Schamroth Pravda ◽

P Codner ◽

H Vaknin Assa ◽

G Vitberg ◽

L Perl ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Regurgitation ◽

Functional Class ◽

Nyha Functional Class ◽

Long Term Follow Up ◽

Valve In Valve ◽

One Year ◽

Valve Implantation

Abstract Introduction The Valve-in-Valve (ViV) technique is an established alternative for the treatment of structural bioprosthetic valve deterioration (SVD). Data describing the long term follow up of patients treated with this approach is scarce. We report on our long-term follow up outcomes of patients with SVD in the Aortic position treated with ViV. Methods Included were patients with symptomatic SVD in the aortic position valve who were treated by Valve in valve transcatheter aortic valve implantation (ViV-TAVI) during the years 20102019 in our center. Three main outcomes were examined during follow up: NYHA functional class, hemodynamic of the VIV-TAVI per echocardiography, and overall mortality. Results Our cohort consisted of 84 patients (mean age 78.8±8.9 years). The indications for aortic ViV were: SVD isolated aortic stenosis in 37.6%, SVD isolated aortic regurgitation in 42.2% and combined valve pathology in 20.0%. Self-expandable and balloon-expandable devices were used in 73 (85.9%) and 12 (14.1%), respectively. Average time of follow up was 3.74±2.4 years. 95% and 91% of patients were in NYHA functional class I/II at 1 and 5 year follow up respectively. At one year the mean trans-aortic valve pressure was 15.3±9.3 and rates of ≥ moderate aortic regurgitation were 3.7%. Survival was 91.4% (95% CI 85.6–97.7) at one year and 79.5% (95% CI 70.2–90.0) at 3 years. Conclusion ViV in the aortic position offers an effective and durable treatment option for patient with SVD, with low rates of all-cause mortality, excellent hemodynamic and improved functional capacity at 3 years follow up. FUNDunding Acknowledgement Type of funding sources: None. NYHA functional class over follow up

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