scholarly journals A case report: black oesophagus as a possible complication of transcatheter aortic valve implantation

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Inês S Gonçalves ◽  
Armando L Bordalo e Sá ◽  
Narcisa Fatela ◽  
Pedro Canas da Silva
Keyword(s):  
Case Report ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
High Rate ◽  
Haemodynamic Instability ◽  
Heart Team ◽  
Transcatheter Aortic Valve ◽  
Acute Necrotizing ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background The increasing number of transcatheter aortic valve implantation (TAVI) in the last few years has unveiled a unique set of events and complications that need prompt recognition and management in order to improve patient outcomes, often involving a multidisciplinary team. Case summary We present a case of a 86-year-old woman with symptomatic severe aortic stenosis that underwent a TAVI and, in the post-procedure period, presented with acute abundant haematemesis, haemodynamic instability, and haemoglobin drop. The diagnosis of acute necrotizing oesophagitis (ANE) was made by upper gastrointestinal endoscopy. Discussion Acute necrotizing oesophagitis is a rare entity caused usually by an ischaemic insult in the presence of predisposing factors; it has a high rate of complications and mortality. To the best of our knowledge, this is the first clinical case report to describe the occurrence of ANE as a possible complication of TAVI and is also an example of the importance of the multidisciplinary approach of these complex patients, which extends even beyond the concept of Heart Team.

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 Acute myocardial infarction associated with prosthetic valve leaflet thrombosis after transcatheter aortic valve implantation: a case report

2020 ◽  
Author(s):  
Johannes Rotta Detto Loria ◽  
Holger Thiele ◽  
Mohamed Abdel-Wahab
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Prosthetic Valve ◽  
Valve Leaflet ◽  
Transcatheter Aortic Valve ◽  
Valve Function ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Fatal thrombo-embolic events like cerebral stroke or myocardial infarction are rare complications of prosthetic heart valve leaflet thrombosis. Nevertheless, prevention and management of leaflet thrombosis is gaining increased attention, particularly with the widespread adoption of transcatheter heart valves. Case summary We herein present the case of a 79-year-old man who had undergone a transcatheter aortic valve implantation procedure. Seven months later, he presented with a non-ST-segment elevation myocardial infarction. Coronary angiography did not reveal obstructive lesions. A dedicated cardiac computed tomography scan showed thrombosis of both right- and non-coronary leaflets of the prosthetic aortic valve, while prosthetic valve function was normal on echocardiography. Transmural myocardial infarction lesions in the midventricular and apical inferior wall were detected by cardiac magnetic resonance imaging. Discussion Subclinical leaflet thrombosis of prosthetic aortic valves is a common finding. In this case report, we show that myocardial infarction presumably due to leaflet thrombosis was the first symptom in an otherwise asymptomatic patient. This finding raises the question of the validity in distinguishing between subclinical and clinical leaflet thrombosis based on prosthetic valve function.

P1676De novo aortic insufficiency following long term LVAD support can be successfully treated with TAVI and a pre-stenting technique

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kofler ◽  
A Unbehaun ◽  
S Buz ◽  
C Klein ◽  
A Meyer ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Transcatheter Aortic Valve Implantation ◽  
High Rate ◽  
Landing Zone ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
Lvad Support

Abstract Background/Introduction Long-term continuous flow left ventricular assist device (cf-LVAD) can result in the development of relevant aortic regurgitation (AR). Although its impact on survival is still controversial, it causes heart failure related symptoms. Current evidence for less invasive strategies to treat AR in cf-LVAD patients is limited. Purpose This study sought to investigate the value of transcatheter aortic valve implantation (TAVI) to treat severe de novo AR in patients on long-term cf-LVAD support. Methods We performed a retrospective analysis of 13 patients with severe AR following cf-LVAD implantation treated with TAVI between 2010 and 2019. TAVI's were performed via transfemoral (n=11), transapical (n=1) and transaxillary (n=1) access route. CoreValve (n=2), LotusValve (n=1), SapienXT (n=1) and Sapien3 (n=9) were used as transcatheter heart valves. In 4 patients, a new off-label strategy using landing-zone pre-stenting with a Sinus-XL stent was used (Figure 1). Results The median time interval from LVAD-implantation to TAVI was 1.7 years [interquartile range (IQR): 1.0 - 3.1]. Median age was 62 years [IQR: 57 - 67]. No procedural mortality or stroke was observed. Overall, device success according to VARC-II criteria was low due to a high rate of second valve necessity (54%). In contrast to the standard implantation technique, device success was 100% when the newly developed pre-stenting technique was applied (Table 1). Aortic regurgitation at discharge was none/trace in all patients. Valve function remained stable in all patients during a median echocardiographic follow-up time of 105 days [IQR: 11 - 298]. Table 1 Overall Sinus-XL prestenting (n=4) NO prestenting (n=9) Device success 7 (54) 4 (100) 3 (33) Procedural mortality 0 (0) 0 (0) 0 (0) Correct positioning of a single valve 7 (54) 4 (100) 3 (33) Intended valve performance 13 (100) 4 (100) 9 (100) Moderate or severe aortic regurgitation 0 (0) 0 (0) 0 (0) Figure 1 Conclusions Transcatheter aortic valve implantation is an efficient tool to treat cf-LVAD induced severe AR. The challenging anatomy of the non-calcified device landing zone causes a relatively high rate of primary device failure, which could be overcome with a pre-stenting technique. Acknowledgement/Funding None

Sheathless transaxillary transcatheter aortic valve implantation using the Portico valve system. Initial experience of a real-world “Heart Team”

2020 ◽  
Vol 73 (2) ◽  
pp. 178-180
Author(s):  
Rosa María Cardenal Piris ◽  
Omar Araji Tiliani ◽  
José Francisco Díaz Fernández ◽  
Nuria Miranda Balbuena ◽  
Antonio Gómez Menchero ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Real World ◽  
Heart Team ◽  
Initial Experience ◽  
Valve System ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

In-hospital outcomes after emergency or prophylactic veno-arterial extracorporeal membrane oxygenation during transcatheter aortic valve implantation: a comprehensive review of the literature

Perfusion ◽  
2019 ◽  
Vol 34 (5) ◽  
pp. 354-363 ◽  
Author(s):  
Giuseppe M. Raffa ◽  
Mariusz Kowalewski ◽  
Paolo Meani ◽  
Fabrizio Follis ◽  
Gennaro Martucci ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Extracorporeal Membrane Oxygenation ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Heart Team ◽  
Emergency Setting ◽  
Membrane Oxygenation ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been used to deal with life-threatening complications as well as back-up or active cardiovascular support during high-risk procedures in patients undergoing transcatheter aortic valve implantation (TAVI). PubMed and MEDLINE electronic databases were searched in order to identify studies with emergency or prophylactic V-A ECMO application in association with TAVI procedures. From November 2012 to November 2017, 14 relevant studies were identified that included 5,115 TAVI patients of whom 102 (2%) required V-A ECMO (22 prophylactically, 66 as an emergency and 14 without a reported indication). The reason for emergency V-A ECMO institution was detailed in 64 patients: left ventricle free wall rupture (n = 14), haemodynamic instability (n = 12), ventricular arrhythmias (n = 7), aortic annulus rupture (n = 6), coronary obstruction (n = 6), low left ventricular output (ejection fraction <35%) (n = 5), uncontrollable bleeding (n = 5), severe aortic regurgitation (n = 4), prosthesis embolisation (n = 3), aortic dissection (n = 1) and respiratory failure (n = 1). Femoral arterial and vein cannulation was the most common access technique for V-A ECMO institution. Major bleeding (n = 7) and vascular access complications (n = 7) were reported after ECMO institution. The overall in-hospital survival was 73% (61% in the emergency vs. 100% in the prophylactic group). V-A ECMO support should be available at any centre performing TAVI and provides effective mechanical circulatory support in an emergency setting. We present an algorithm to aid decisions about prophylactic circulatory assistance with V-A ECMO and it should form part of the heart team discussion before a TAVI procedure is undertaken.

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