scholarly journals P1362 Echocardiographic findings and BNP levels in patients with valve-in-valve implantation in small failed mitroflow aortic prosthesis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Muscoli ◽  
V Cammalleri ◽  
J Cosma ◽  
M Zuccaro ◽  
M Macrini ◽  
...  
Keyword(s):  
Clinical Results ◽  
Aortic Valves ◽  
Structural Valve Deterioration ◽  
Before And After ◽  
Patient Prosthesis Mismatch ◽  
Valve In Valve ◽  
Echocardiographic Assessment ◽  
Valve Implantation ◽  
Echocardiographic Findings

Abstract BACKGROUND Early structural valve deterioration (SVD) frequently occurs in Mitroflow aortic bioprosthesis, especially for small sizes (19-mm and 21-mm), and it is associated with reduced overall survival. Treatment by percutaneous valve-in-valve (ViV) implantation is considered a challenging procedure. This is mainly due to an elevated risk of coronary ostia obstruction and high residual post-procedural mean gradients (mG), particularly when severe pre-existing patient-prosthesis mismatch (PPM) is present. PURPOSE Aim of our study was to assess the feasibility of transfemoral ViV in small Mitroflow aortic valves using supra-annular self-expanding valves, named CoreValve and Evolut R and Acurate neo and report the midterm clinical results by comparing serum natriuretic peptide type B levels (BNP) before the procedure and at a mean follow-up of 2 years. METHODS This is an observational study including 11 patients with stenotic-type SVD of small Mitroflow aortic valves, considered at high/prohibitive risk for surgical reoperation, who underwent ViV implantation between July 2012 and March 2018. We performed echocardiographic assessment of valve hemodynamics (according to VARC-2 definitions) before and after the procedure and during the follow-up. We used the BNP ratio (the ratio between measured serum BNP/NT-proBNP level and maximal normal level) to compare BNP results before the procedure and at follow-up. All-cause mortality during the hospitalization and follow-up was also reported. RESULTS The Mitroflow size was 19-mm in 4 patients and 21-mm in 7 patients. Pre-existing severe PPM was present in 4 patients and moderate PPM in 7. CoreValve 26 was implanted in 2 patients, EvolutR 23 in 5 and Acurate neo S in 4 patients. We reported no coronary obstruction, deaths or other major events during the hospitalization. At a mean follow-up of 2 years one patient died. The baseline aortic mG of 56 ± 19 mmHg has significantly reduced after the procedure to 16,6 ± 8 mmHg (p < 0.0001) and follow-up 29,6 ± 16 mmHg (p = 0.008). A post-procedural mG≥20, but <40 mmHg, was observed in 3 patients. BNP ratio at baseline was 14,6 ± 12; only one patient had a BNP ratio <3. At follow-up (n = 7 patients), BNP ratio was significantly lowered to 1,5 ± 1,08 (p = 0.01) with only one patient with a BNP ratio >3. Patients with mPG ≥20 mmHg did not show differences in terms of mortality and reduction of serum BNP levels. CONCLUSIONS In our experience the ViV procedure on small degenerated aortic Mitroflow bioprosthesis appears to be technically feasible and provides good midterm clinical results with a net reduction in serum BNP levels, although an increase in mG was observed. Even though a post-procedural mG ≥20 mmHg is considered indicative of suboptimal aortic valve hemodynamics (according to VARC-2 criteria), its correlation with worse outcomes remains unclear and deserves further investigations.

Transcatheter Valve-in-Valve Implantation for Deteriorated Aortic Bioprosthesis: Initial Clinical Results and Follow-Up in a Series of High-Risk Patients

2012 ◽  
Vol 93 (3) ◽  
pp. 734-741 ◽  
Author(s):  
Manuel Wilbring ◽  
Bjoern Sill ◽  
Sems Malte Tugtekin ◽  
Konstantin Alexiou ◽  
Gregor Simonis ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Results ◽  
High Risk Patients ◽  
Risk Patients ◽  
Valve In Valve ◽  
Transcatheter Valve ◽  
Valve Implantation

A valve-in-valve transcatheter aortic valve implantation with commissural alignment using advanced imaging reconstruction: a case report

2020 ◽  
Vol 3 (10) ◽  
pp. 01-05
Author(s):  
Marco Angelillis
Keyword(s):  
Aortic Valve ◽  
Severe Aortic Stenosis ◽  
Coronary Intervention ◽  
Easy Access ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Structural Valve Deterioration ◽  
Valve In Valve ◽  
Transcatheter Valve ◽  
Valve Implantation

Transcatheter valve in valve (ViV) implantation actually represents a valid alternative to surgical reinterventions in patients with previous surgical aortic valve replacement (AVR). In patients less than 80 years old, it is crucial to correctly position the new valve leaving a feasible and easy access to coronary ostia, both for future percutaneous coronary intervention (PCI) than for a future possible TAVinTAV procedure. We report a 71 year old man with prior AVR presented with structural valve deterioration (SVD) leading to severe aortic stenosis. In order to guarantee comfortable coronary access we aligned, the commissures of the new percutaneous valve with the ones of the surgical bioprothesis by reconstructing the headframes of the surgical bioprosthesis with computer tomography (CT) and fluoro-CT.

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.

scholarly journals Valve-in-Valve Implantation of Medtronic CoreValve Prosthesis in Patients with Failing Bioprosthetic Aortic Valves

2012 ◽  
Vol 5 (5) ◽  
pp. 689-697 ◽  
Author(s):  
Axel Linke ◽  
Felix Woitek ◽  
Marc W. Merx ◽  
Conrad Schiefer ◽  
Sven Möbius-Winkler ◽  
...  
Keyword(s):  
Aortic Valves ◽  
Valve In Valve ◽  
Medtronic Corevalve ◽  
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.

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

2018 ◽  
Vol 72 (13) ◽  
pp. B152-B153
Author(s):  
Abdullah Alenezi ◽  
John Webb ◽  
Jonathon Leipsic ◽  
Philipp Blanke ◽  
David Wood ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bioprosthetic Valve ◽  
Valve In Valve ◽  
Hemodynamic Function ◽  
Valve Implantation

4069From first in man transcatheter aortic valve implantation, a 15-year experience

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Avinee ◽  
E Durand ◽  
T Levesque ◽  
P Y Litzler ◽  
J N Dacher ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Transcatheter Aortic Valve ◽  
Kaplan Meier ◽  
Transcatheter Heart Valve ◽  
Structural Valve Deterioration ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Since the first-in-man transcatheter aortic valve implantation (TAVI) performed in 2002, the number of procedures has dramatically increased. However, long-term data regarding outcome and valve durability remain poor. Purpose We aimed to evaluate the evolution of 30-day outcomes over years and long-term mortality and valve durability after TAVI. Methods All consecutive patients presenting with severe symptomatic aortic stenosis treated by TAVI in our center were included prospectively. Clinical and echocardiographic follow-up was performed at 30 days and annually thereafter. Survival curves were constructed using Kaplan-Meier analysis. We also evaluated valve durability according to the European standardized definition of structural valve deterioration. Results Between 2002 and 2018, 1530 consecutive patients underwent TAVI including 1285 (84.0%) patients via a femoral approach. A balloon-expandable transcatheter heart valve was predominantly used (1421 patients; 92.9%). The annual transfemoral approach rate increased progressively to reach 93.3%. Age of patients remained stable over time with a global mean age of 83.7±6.5 years old. Logistic EuroSCORE decreased from 49.2±8.2% to 14.3±8.6% (p<0.0001). Thirty-day mortality dramatically decreased below 3% since 2015 and was 0% in 2018. Similarly, major vascular complications decreased from 50.0% in the first year to less than 1% since 2017 (p=0.001). The length of hospital-stay progressively shortened up to a median of 2 days in 2018. The Kaplan-Meier survival estimation was 82.3%, 60.3%, 33.0%; 11.7% and 8.9% respectively at 1, 3, 5, 8 and 10 years. On long-term follow-up the mean aortic gradient remained unchanged (Figure), and only five patients presented a severe prosthetic valve deterioration. Among them, four patients successfully benefited from a valve in valve TAVI procedure. The competing risk analysis at 10 years estimates risk for severe and moderate-or-severe valve deterioration of 1.9±0.9% and 4.3±1.3% respectively. TEE mean transaortic gradient Conclusions Long-term (up to 10 years) follow-up of our large pioneer series of patients treated by TAVI shows a dramatic improvement of outcomes and no warning signs of valve deterioration suggesting very encouraging valve durability, using predominantly, a balloon expandable prosthesis. Further studies are warranted to study valve durability after TAVI before extension to lower risk patients.

scholarly journals Interventional Echocardiography of the MV: What the Interventionalist Wants to Know

2018 ◽  
Vol 23 (1) ◽  
pp. 37-47 ◽  
Author(s):  
Ludmil Mitrev ◽  
Nayan Desai ◽  
Ahmed Awad ◽  
Sajjad Sabir
Keyword(s):  
Mitral Valve ◽  
Prosthetic Valve ◽  
The Past ◽  
Interventional Echocardiography ◽  
Valve In Valve ◽  
Procedural Guidance ◽  
Valve Implantation ◽  
Transcatheter Interventions

The past 2 decades have seen a proliferation of transcatheter mitral valve (MV) therapies, which are less invasive and distinct from surgical MV repair or replacement. The commonly used MV transcatheter therapies include (1) percutaneous mitral balloon commissurotomy (PMBC) for rheumatic mitral stenosis; (2) edge-to-edge repair with the MitraClip for mitral regurgitation; (3) valve-in-valve implantation in bioprosthetic MV, native MV, or mitral ring; and (4) closure of paravalvular leaks (PVLs). This article will focus on the use of echocardiography in the diagnosis, patient selection, procedural guidance, and postprocedural follow-up for PMBC, with notes on the role of transesophageal echocardiography in transcatheter interventions for prosthetic valve degeneration and PVL closure.

scholarly journals Clinical Results of Percutaneous Transluminal Angioplasty and Stenting for Intracranial Vertebrobasilar Atherosclerotic Stenoses and Occlusions

2004 ◽  
Vol 10 (2_suppl) ◽  
pp. 21-25 ◽  
Author(s):  
M. Tsuura ◽  
T. Terada ◽  
O. Masuo ◽  
T. Tsumoto ◽  
H. Yamaga ◽  
...  
Keyword(s):  
Clinical Results ◽  
Transluminal Angioplasty ◽  
Morbidity Rate ◽  
Cerebellar Haemorrhage ◽  
Total Occlusion ◽  
Vertebrobasilar Artery ◽  
Before And After ◽  
High Risk Lesion ◽  
Angioplasty And Stenting

Eighteen patients with intracranial vertebrobasilar stenosis and occlusion were treated by PTA or stenting. In 11 of 18 cases, only PTA was performed and in seven of 18 cases, we used stents. The mean stenosis before and after PTA/stenting was 82.8% and 22.3%, respectively. In 11 cases of PTA only, the stenotic rate decreased from 81.8% to 29.6%, while 85.0% of the stenotic rate remarkably reduced to 6.0% in seven cases of stenting. The 30 days morbidity and 30 days mortality rate were 5.5% and 5.5%, respectively. There was only one haemorrhagic complication (cerebellar haemorrhage) in cases of stenting, and no ischemic events during or after the procedures. Restenosis (more than 50% stenosis) occurred in four of 18 cases (22.2%) during mean follow-up period of 12 months. Two patients with VA occlusion before treatment, developed restenosis and reocclusion. Complete total occlusion seems to be a high-risk lesion and strict follow-up is required. In this study, PTA/stenting for intracranial vertebrobasilar artery stenosis or occlusion is an effective treatment, but strict indications may be required because procedure-related 30 days morbidity rate was 5.5% in addition to unclear natural history.

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