Transcatheter Aortic Valve Replacement for Bicuspid Aortic Insufficiency After Valve-Sparing Aortic Root Replacement

ObjectOur goal was to assess the implant depth of a Venus-A prosthesis during transcatheter aortic valve replacement (TAVR) when the areas of eccentric calcification were distributed in different sections of the aortic valve.MethodsA total of 53 patients with eccentric calcification of the aortic valve who underwent TAVR with a Venus-A prosthesis from January 2018 to November 2019 were retrospectively analyzed. The patients were divided into three groups (A, B, and C) according to the location of the eccentric calcification, which was determined by preprocedural computerized tomography angiography (CTA) images. The prosthesis release process and position were evaluated by contrast aortography during TAVR, and the differences in valve implant depths were compared among the three groups. The effects of different aortic root structures and procedural strategies on prosthesis implant depth were analyzed.ResultsEleven patients had eccentric calcification in region A; 19 patients, in region B; and 23 patients, in region C. The patients with eccentric calcification in region B had a higher risk of prosthesis migration (10.5% upward and 21.1% downward), and the position of the prosthesis after TAVR in group B was the deepest among the three groups. When eccentric calcification was located in region A or C, the prosthesis was released at the standard position with more stability, and the location of the prosthesis was less deep after TAVR (region A: 4.12 ± 3.4 mm; region B: 10.2 ± 5.3 mm; region C: 8.4 ± 4.0 mm; region A vs. region B, P = 0.0004; region C vs. region B; and P = 0.0360). In addition, the left ventricular outflow tract (LVOT) (P = 0.0213) and aortic root angulation (P = 0.0263) also had a significant effect on implant depth in the aortic root structure of the patients. The prosthesis size was 28.3 ± 2.4 in the deep implant group and 26.4 ± 2.0 in the appropriate implant group (P = 0.0068).ConclusionThe implant depth of the Venus-A prosthesis is closely related to the distribution of eccentric calcification in the aortic valve during TAVR. Surgeons should adjust the surgical strategy according to aortic root morphology to prevent prosthesis migration.

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TCT-20 Aortic Root Anatomy in Low-Risk Patients After Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve: Impact on Coronary Access and Repeat Aortic Valve Interventions

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2019.08.045 ◽

2019 ◽

Vol 74 (13) ◽

pp. B20

Author(s):

Toby Rogers ◽

Michael Fuery ◽

Jaffar Khan ◽

Paige Craig ◽

Rebecca Torguson ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Aortic Root ◽

Transcatheter Aortic Valve Replacement ◽

Low Risk ◽

Root Anatomy ◽

Transcatheter Aortic Valve ◽

Risk Patients

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Valve-in-valve transcatheter aortic valve replacement in a young patient with a suspected COVID-19 infection: a surgical dilemma in the era of the COVID-19 pandemic

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa193 ◽

2020 ◽

Vol 58 (1) ◽

pp. 188-189

Author(s):

Robert Bauernschmitt ◽

Philip Gabriel ◽

Roman Gottardi ◽

Ralf Sodian

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Left Lung ◽

Aortic Insufficiency ◽

Pulmonary Complications ◽

Rt Pcr ◽

Transcatheter Aortic Valve ◽

Valve In Valve

Abstract We report on a case of a 57-year-old male patient, who underwent full root replacement in 2005 and now presented with high grade aortic insufficiency. On admission, the patient underwent a computed tomography scan which demonstrated interstitial infiltration in the left lung, highly suspicious for a COVID-19 infection that could not be confirmed by reverse transcription polymerase chain reaction (RT-PCR) testing. As there usually is a delay between infection and positive RT-PCR test results, the initial decision was to perform additional testing. However, the patient deteriorated quickly in spite of optimal medical therapy making urgent aortic valve replacement necessary. We decided to perform transcatheter aortic valve replacement to avoid cardiopulmonary bypass with shorter operative times, presumably shorter ventilation times and duration of intensive care unit stay, and thus a lesser risk for pulmonary complications.

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