Reducing severe intraprocedural complications during transcatheter aortic valve implantation with an interdisciplinary heart team approach

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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Transcatheter aortic valve implantation using a direct aortic approach: a single-centre Heart Team experience

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivu247 ◽

2014 ◽

Vol 19 (5) ◽

pp. 777-781 ◽

Cited By ~ 15

Author(s):

Hafid Amrane ◽

Fabiano Porta ◽

Ad J. van Boven ◽

Piet W. Boonstra ◽

Sjoerd H. Hofma ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Heart Team ◽

Single Centre ◽

Transcatheter Aortic Valve ◽

Team Experience ◽

Aortic Valve Implantation ◽

Valve Implantation

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

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz069 ◽

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.

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