scholarly journals Percutaneous Valvular Closure Followed by TAV-in-TAV Intervention during a Single Procedure in order to Treat a Severe Paravalvular Leak after Performing TAVI in a Bicuspid Aortic Stenosis

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Georgios Tzimas ◽  
Eric Eeckhout ◽  
Panagiotis Antiochos ◽  
Christan Roguelov ◽  
Stephane Fournier ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Paravalvular Leak ◽  
Haemodynamic Instability ◽  
Single Procedure ◽  
Transcatheter Aortic Valve ◽  
First Case ◽  
Effective Reduction ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

In an era where transcatheter aortic valve implantation (TAVI) indications and utilization are expanding beyond high-risk patients, paravalvular leak remains the intervention’s Achilles heel. Effective reduction of paravalvular leak is important in order to ensure an optimal clinical outcome. We present here the first case report in which percutaneous valvular closure using Amplatzer plugs followed by a TAV-in-TAV intervention during the same procedure managed to resolve a severe paravalvular leak with haemodynamic instability, after TAVI for a bicuspid aortic stenosis.

Abstract 2307: Contemporary Perioperative Results of Isolated Aortic Valve Replacement for Aortic Stenosis: Implications for Transcatheter Aortic Valve Implantation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
S C Malaisrie ◽  
Patrick M McCarthy ◽  
Edwin C McGee ◽  
Richard Lee ◽  
Vera Rigolin ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Operative Mortality ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (AVI) is compelling for some high-risk patients with aortic stenosis (AS). However, comparison of procedure outcomes with older surgical series may overestimate operative risk. We therefore analyzed our contemporary series of isolated aortic valve replacement (AVR) for AS. From April 2004 to January 2008, 642 patients underwent AVR with or without concomitant cardiac procedures. Of these patients, 175 patients had an isolated AVR, and 140 patients underwent isolated AVR for AS. The characteristics were age 68, male gender 56%, ejection fraction 57%. Sixty-four percent had a minimally-invasive AVR and 18% were reoperations. Twenty percent were 80 years old or greater, 35% were in NYHA functional class III-IV, and 4% had an estimated operative mortality of 10% or greater using the Society of Thoracic Surgery (STS) risk calculator. Thirty-day mortality was 0%, but there was one in-hospital death (0.7%) from complications of an esophageal perforation. Reoperation for bleeding occurred in 5.7%, cerebrovascular accident (CVA) in 0%, acute renal failure (ARF) in 2.9%, myocardial infarction (MI) in 0%. Bioprosthetic valves were used in 98.6% and mechanical in 1.4%. Mean gradient decreased from 48 mmHg to10 mmHg. Actuarial survival was 97% and 90% at 1 and 3 years. Patients >80 years (n=28) were more likely to have an increased length of hospital stay (9.8 versus 6.3 days, p=0.01) and less likely to be discharged to home (48% versus 86%, p<0.01) as compared to patients <80 years. Today, AVR for AS can be performed in many high-risk patients with low operative mortality and morbidity, although patients over 80 years are at greater risk of prolonged recovery. Transcatheter AVI should be compared to this high threshold.

Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis – Overcoming the Challenges

2011 ◽  
Vol 6 (2) ◽  
pp. 165 ◽  
Author(s):  
Thomas Walther ◽  
Helge Möllmann ◽  
Johannes Blumenstein ◽  
Jörg Kempfert ◽  
◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Heart Team ◽  
High Risk Patients ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) has evolved as one of the most important innovations in cardiovascular medicine during the past five years. By means of transfemoral (TF) and transapical (TA) AVI elderly and high-risk patients with symptomatic aortic stenosis (AS) are being routinely treated using a minimally invasive approach. Some challenges have to be overcome to obtain perfect results: patient screening and eventual selection is important, conduct of the procedures by an experienced and interdisciplinary heart team is ideal and intense post-operative therapy is required for the patients. Currently available devices, the Corevalve™ (CV, Medtronic Inc.) and SAPIEN™ (ES, Edwards Inc.) prostheses, which are Conformité Européenne (CE) Mark approved for TF (CV and ES) and TA (ES) implantations, are first-generation prostheses. Future developments will focus on reduction of potential paravalvular leakage as well as improved features during valve implantation, most importantly repositioning and retrievability. TAVI has already gained an important position for the treatment of elderly high-risk patients with AS.

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