Valve‐in‐valve transcatheter aortic valve replacement in the context of infective endocarditis: A word of caution

Abstract Background A rare, but serious, complication following transcatheter aortic valve replacement (TAVR) is the occurrence of an iatrogenic ventricular septal defect (VSD). Case summary We describe a case of an 80-year-old female who was referred with severe aortic stenosis for TAVR. Following thorough evaluation, the heart team consensus was to proceed with implantation via a transapical approach of an ACURATE neo M 25 mm valve (Boston Scientific, Natick, MA, USA). The valve was deployed harnessing transoesophageal echocardiographic (TOE) guidance under rapid pacing with post-dilation. Directly afterwards a very high VSD close to the aortic annulus was detected. As the patient was haemodynamically stable, the procedure was ended. The next day another TOE revealed a shunt volume (left-to-right ventricle) between 50% and 60%. Because the defect was partly located between the stent struts of the ACURATE valve decision was made to fix this leakage with implantation of a further valve and we chose an EVOLUT Pro 29 mm (Medtronic Inc., Minneapolis, MN, USA). The valve-in-valve was implanted 2–3 mm below the lower edge of the first valve, more towards the left ventricular outflow tract (LVOT) with excellent result: VSD was reduced to a very small residual shunt without any hemodynamic relevance. Discussion We suggest that an iatrogenic VSD located near the annulus may be treated percutaneously in a bail-out situation with implantation of a second valve that should be implanted slightly more into the LVOT to cover the VSD.

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CoreValve bioprosthesis dysfunction treated with a Sapien 3 valve‐in‐valve transcatheter aortic valve replacement and BASILICA technique

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.29544 ◽

2021 ◽

Author(s):

Ravi K Sharma ◽

Mark K Tuttle ◽

Marie‐France Poulin ◽

Roger J Laham

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Valve In Valve ◽

Sapien 3

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VALVE-IN-VALVE TRANSCATHETER AORTIC-VALVE REPLACEMENT WITH BASILICA IN A PATIENT WITH HISTORY OF EVANS SYNDROME, HEPARIN INDUCED THROMBOCYTOPENIA AND HEMODIALYSIS. IS IT EVEN POSSIBLE?

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)03712-8 ◽

2021 ◽

Vol 77 (18) ◽

pp. 2357

Author(s):

Mahmoud Samy Ahmed ◽

Toka Amin ◽

Akhtar Amin ◽

Mouhamed Nashawi ◽

Justin Haloot ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Evans Syndrome ◽

Heparin Induced Thrombocytopenia ◽

Transcatheter Aortic Valve ◽

History Of ◽

Valve In Valve

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Transesophageal echocardiogram to guide valve-in-valve Transcatheter aortic valve replacement of a failed Medtronic-freestyle aortic prosthesis

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2021.08.026 ◽

2021 ◽

Author(s):

Ahmed M. Elzanaty ◽

Mohammed Mahmood ◽

Mohamed Mhanna ◽

Salik Nazir ◽

John Letcher ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Transesophageal Echocardiogram ◽

Aortic Prosthesis ◽

Transcatheter Aortic Valve ◽

Valve In Valve

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Bioprosthetic Valve Fracture to Facilitate Valve-in-Valve Transcatheter Aortic Valve Replacement

Structural Heart Cases ◽

10.1016/b978-0-323-54695-9.00089-5 ◽

2019 ◽

pp. 180-181

Author(s):

Adnan K. Chhatriwalla

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Bioprosthetic Valve ◽

Transcatheter Aortic Valve ◽

Valve In Valve

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Abstract 13923: Incidence and Outcomes of Infective Endocarditis After 180 Days in Transcatheter Aortic Valve Replacement and Mitraclip

Circulation ◽

10.1161/circ.142.suppl_3.13923 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Manpreet Kaur ◽

Anas M Saad ◽

Keerat Ahuja ◽

Simrat Kaur ◽

Toshiaki Isogai ◽

...

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

International Classification Of Diseases ◽

Chi Square ◽

Transcatheter Aortic Valve ◽

Classification Of Diseases ◽

Chi Square Test

Background: Infective endocarditis (IE) after Transcatheter aortic valve replacement (TAVR) and Mitra Clip (MC) occurs less commonly but is associated with grave complications. We aim to report the incidence and outcomes of IE within 180 days of TAVR and MC. Methods: We used the Nationwide Readmissions Database (NRD) between 2014 and 2017 to select patients who underwent either TAVR or MC between January and June every year (to allow for at least 180 days of follow up in the NRD) using the appropriate International Classification of Diseases-9 th and 10 th revision (ICD) codes. We performed a chi-square test to compare baseline characteristics and rates of IE after TAVR and MC procedures. All statistical analyses were performed the using SPSS version 26. Results: We included 68,270 and 7,080 patients who underwent TAVR and MC respectively, of which 0.68% vs. 0.94% (P=.012), developed IE respectively within 180 days of procedure. During that index hospitalization, in-hospital mortality rates did not differ between the two groups (15.08% in TAVR vs. 17.91%, in MC P=.587). Other outcomes are presented in table 1. Conclusion: Our study suggests that the overall incidence of IE following TAVR and MC is relatively low but appropriate preventive measures should be taken after the procedures to reduce the morbidity and mortality. Further studies and analysis are required in modern MC and TAVR techniques to circumvent this critical complication.

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Direct Transcatheter Valve Deployment via Sternotomy for Complex Aortic Valve Reoperation

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984519854825 ◽

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.

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