PLACEMENT OF A VALVE-IN-VALVE (VIV) TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) IN THE SETTING OF AORTIC DISSECTIONS AND A HIGH RISK OF CORONARY OBSTRUCTION

2020 ◽  
Vol 75 (11) ◽  
pp. 2448
Author(s):  
Hailu Tilahun ◽  
Danny Dvir
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Valve In Valve ◽  
Aortic Dissections ◽  
Coronary Obstruction

Direct Transcatheter Valve Deployment via Sternotomy for Complex Aortic Valve Reoperation

2019 ◽  
Vol 14 (4) ◽  
pp. 365-368
Author(s):  
Tom C. Nguyen ◽  
Alexander P. Nissen ◽  
Pranav Loyalka ◽  
Eyal E. Porat
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
High Risk Patient ◽  
Direct Vision ◽  
Risk Patient ◽  
Transcatheter Aortic Valve ◽  
Valve In Valve

Reoperative aortic valve replacement is associated with increased morbidity. Valve-in-valve transcatheter aortic valve replacement offers a less invasive alternative to traditional reoperation. However, cases of valve failure after valve-in-valve transcatheter aortic valve replacement represent a complex surgical challenge. We present a case requiring a complex reoperative aortic valve replacement due to structural valve deterioration after multiple previous valve-in-valve transcatheter aortic valve replacements. We performed removal of 3 previous valve-in-valve transcatheter aortic valves, bioprosthetic leaflet excision, and intentional bioprosthetic fracture under direct vision for annular enlargement. This facilitated direct insertion of a new transcatheter aortic valve for expedient and successful management of recurrent aortic stenosis in a very high-risk patient. Creative use of leaflet excision, intentional bioprosthetic fracture, and insertion of a new transcatheter aortic valve under direct vision, proved efficient and successful in a high-risk patient with few surgical options.

scholarly journals Comparison of in-hospital outcomes and readmissions for valve-in-valve transcatheter aortic valve replacement vs. reoperative surgical aortic valve replacement: a contemporary assessment of real-world outcomes

2020 ◽  
Vol 41 (29) ◽  
pp. 2747-2755 ◽  
Author(s):  
Sameer A Hirji ◽  
Edward D Percy ◽  
Cheryl K Zogg ◽  
Alexandra Malarczyk ◽  
Morgan T Harloff ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Aortic Valves ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Valve In Valve

Abstract Aims We sought to perform a head-to-head comparison of contemporary 30-day outcomes and readmissions between valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) patients and a matched cohort of high-risk reoperative surgical aortic valve replacement (re-SAVR) patients using a large, multicentre, national database. Methods and results We utilized the nationally weighted 2012–16 National Readmission Database claims to identify all US adult patients with degenerated bioprosthetic aortic valves who underwent either VIV-TAVR (n = 3443) or isolated re-SAVR (n = 3372). Thirty-day outcomes were compared using multivariate analysis and propensity score matching (1:1). Unadjusted, VIV-TAVR patients had significantly lower 30-day mortality (2.7% vs. 5.0%), 30-day morbidity (66.4% vs. 79%), and rates of major bleeding (35.8% vs. 50%). On multivariable analysis, re-SAVR was a significant risk factor for both 30-day mortality [adjusted odds ratio (aOR) of VIV-SAVR (vs. re-SAVR) 0.48, 95% confidence interval (CI) 0.28–0.81] and 30-day morbidity [aOR for VIV-TAVR (vs. re-SAVR) 0.54, 95% CI 0.43–0.68]. After matching (n = 2181 matched pairs), VIV-TAVR was associated with lower odds of 30-day mortality (OR 0.41, 95% CI 0.23–0.74), 30-day morbidity (OR 0.53, 95% CI 0.43–0.72), and major bleeding (OR 0.66, 95% CI 0.51–0.85). Valve-in-valve TAVR was also associated with shorter length of stay (median savings of 2 days, 95% CI 1.3–2.7) and higher odds of routine home discharges (OR 2.11, 95% CI 1.61–2.78) compared to re-SAVR. Conclusion In this large, nationwide study of matched high-risk patients with degenerated bioprosthetic aortic valves, VIV-TAVR appears to confer an advantage over re-SAVR in terms of 30-day mortality, morbidity, and bleeding complications. Further studies are warranted to benchmark in low- and intermediate-risk patients and to adequately assess longer-term efficacy.

scholarly journals The Current Perspectives in Valve-in-Valve Transcatheter Aortic Valve Replacement

2021 ◽  
Author(s):  
Takashi Murashita
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Alternative Treatment ◽  
Transcatheter Aortic Valve Replacement ◽  
Attractive Alternative ◽  
Transcatheter Aortic Valve ◽  
Number Of Patients ◽  
Valve In Valve

The increased use of bioprostheses in aortic valve replacement has led to increased number of patients with structural valve degeneration. Since reoperation for failed bioprostheses carries a high risk, a valve-in-valve transcatheter aortic valve replacement has become an attractive alternative treatment. However, there remains technical challenges and controversies in this field. Herein, we discuss the current perspectives in valve-in-valve transcatheter aortic valve replacement.

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