Redo aortic valve replacement with a non-conventional intraoperative decision to avoid left main stem obstruction.

Redo aortic valve surgery for failure of a previously implanted valve is always challenging. In case of small-sized implanted valves, the use of a balloon-expanding Sapien-3 valve can enhance the final effective orifice area, avoid complex annulus enlargement techniques, and can reduce operative time and morbidities. We describe a case where after explanting a failed 19mm St. Jude mechanical aortic valve and further deployment of a 23mm Sapien-3 valve, the left coronary ostia was obstructed by the skirt of the transcatheter prosthesis. After careful removal of a little part of the skirt, we were able to restore the coronary flow and the patient had a favorable outcome.

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EFFECTIVE ORIFICE AREA REFERENCE VALUES WITH THE DIFFERENT SIZES OF THE SAPIEN 3 BALLOON-EXPANDING TRANSCATHETER AORTIC VALVE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(16)30402-8 ◽

2016 ◽

Vol 67 (13) ◽

pp. 401

Author(s):

Brandon S. Oberweis ◽

Nadira Hamid ◽

Omar Khalique ◽

Isaac George ◽

Tamim Nazif ◽

...

Keyword(s):

Aortic Valve ◽

Reference Values ◽

Effective Orifice Area ◽

Orifice Area ◽

Transcatheter Aortic Valve ◽

Sapien 3

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Transcatheter Aortic Valve Implantation into a Stentless Prosthetic Valve with a Low Position of the Left Main Coronary Artery

The Heart Surgery Forum ◽

10.1532/hsf98.20111174 ◽

2012 ◽

Vol 15 (5) ◽

pp. 268

Author(s):

Giuseppe D'Ancona ◽

Miralem Pasic ◽

Stephan Dreysse ◽

Thorsten Drews ◽

Semih Buz ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Left Main Coronary Artery ◽

High Risk Patient ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Left Main ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Recently during a transcatheter aortic valve implantation (TAVI), we were faced with a problem that seemed to be untreatable by TAVI. It was difficult to decide whether to perform atypical TAVI or to convert to conventional redo aortic valve surgery in an extremely high-risk patient with a degenerated stentless aortic bioprosthesis.

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Abstract 17635: Can Published Reference Values Predict Patient-prosthesis Mismatch?

Circulation ◽

10.1161/circ.132.suppl_3.17635 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Prerna Bansal ◽

Muaz Abudiab ◽

Kalyan Chaliki ◽

Marella Punnaiah ◽

Hari Chaliki

Keyword(s):

Aortic Valve ◽

Reference Values ◽

Reference Value ◽

Valve Surgery ◽

Effective Orifice Area ◽

Aortic Valve Surgery ◽

Area Index ◽

True Incidence ◽

Advanced Planning ◽

Patient Prosthesis Mismatch

Background: Patient-prosthesis mismatch (PPM) is still a frequently encountered problem after aortic valve surgery for aortic stenosis(AS). Advanced planning for prevention of PPM would be beneficial. We hypothesized that identification of severe PPM based on chosen surgical valve will predict development of severe PPM after surgery. Methods: Fifty one patients (74±13yrs) with severe aortic valve stenosis who underwent aortic valve surgery had postoperative echocardiogram (TTE) within 6 months. Severe PPM was defined as effective orifice area index (EOAI)<0.65 cm2/m2.We calculated predicted severe PPM using published references values of the prosthetic valve. We used mean value and the values one standard deviation above and below. We compared these values to the actual PPM based on postoperative TTE. Results: All patients had severe AS (MG50±7 mm Hg) and an LV EF of 56±15%. Forty four patients had tissue valves implanted and 7 had mechanical valves implanted. Mean time between postoperative TTE and surgery was 39± 60 days. When the mean reference values for the valve implanted was used, only 1 patient (2%) was predicted to have severe PPM. However, based on postoperative TTE, 6 patients (13%) had severe PPM. There was no correlation between EOAI based on postop TTE and mean published reference values (Figure).When the EOAI below one SD of the published reference value was chosen, the predicted incidence of severe PPM was 38%. When the EOAI above one SD was chosen for the reference value none of the patients were predicted to have PPM. Sensitivity and specificity to identify severe PPM was 17% and 100% for mean published reference value while it was 0% and 100% for +1 SD and 83% and 68% for -1 SD. Conclusions: 1) Use of mean published reference values markedly under estimate the true incidence of post-operative PPM and has unacceptably low sensitivity. 2) Predicted occurrence of PPM was widely variable (0% to 38%) based on the published reference values. Larger studies are needed.

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Sapien 3 versus Sapien XT Balloon-expanding Valve for Transcatheter Aortic Valve Replacement: Improved Immediate and Late Outcomes at the Expense of Smaller Effective Orifice Area

Korean Circulation Journal ◽

10.4070/kcj.2020.0353 ◽

2020 ◽

Vol 50 (10) ◽

pp. 923

Author(s):

Young-Guk Ko

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Effective Orifice Area ◽

Orifice Area ◽

Transcatheter Aortic Valve ◽

Sapien 3

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Incidence and Impact of Patient-Prosthesis Mismatch in Isolated Aortic Valve Surgery

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2015.108 ◽

2014 ◽

Vol 3 (4) ◽

pp. 624-629

Author(s):

Selman Dumani ◽

Ermal Likaj ◽

Andi Kacani ◽

Laureta Dibra ◽

Elizana Petrela ◽

...

Keyword(s):

Aortic Valve ◽

Perioperative Complications ◽

Pulmonary Complications ◽

Valve Surgery ◽

Effective Orifice Area ◽

Aortic Valve Surgery ◽

Low Cardiac Output ◽

Early Results ◽

Patient Prosthesis Mismatch ◽

Study Population

AIM: The mains topics of this work are the incidence of patient-prosthesis mismatch and the influence in the early results of isolated aortic valve surgery.METHODS: In 193 patients isolated aortic valve surgery was performed. The study population was divided in three subgroups: 20 patients with severe, 131 patients with moderate and 42 patients without patient-prosthesis mismatch. The indexed effective orifice area was used to define the subgroups. Operative mortality and perioperative complications were considered the indicators of the early results of aortic valve surgery.RESULTS: The incidence of severe and moderate patient-prosthesis mismatch was respectively 10.3% and 67.8%. Hospital mortality and perioperative complications were: mortality 5% vs. 3.1% vs. 2.4% (p = 0.855), low cardiac output 5% vs. 6.9% vs. 4.8% (p = 0.861); pulmonary complications 5% vs. 3.1 vs. 0.0% (p = 0.430); exploration for bleeding 5% vs. 0.8% vs. 2.4% (p = 0.319); atrial fibrillation 30% vs. 19.8% vs. 11.9% (p = 0.225); wound infection 5% vs. 0.8% vs. 0.00% (p = 0.165), respectively for the group with severe, moderate and without patient-prosthesis mismatch.CONCLUSIONS: Patient-prosthesis mismatch is a common occurrence in aortic valve surgery. This phenomenon does not affect the early results of aortic valve surgery.

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