A valve-in-valve transcatheter aortic valve implantation with commissural alignment using advanced imaging reconstruction: a case report

2020 ◽  
Vol 3 (10) ◽  
pp. 01-05
Author(s):  
Marco Angelillis
Keyword(s):  
Aortic Valve ◽  
Severe Aortic Stenosis ◽  
Coronary Intervention ◽  
Easy Access ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Structural Valve Deterioration ◽  
Valve In Valve ◽  
Transcatheter Valve ◽  
Valve Implantation

Transcatheter valve in valve (ViV) implantation actually represents a valid alternative to surgical reinterventions in patients with previous surgical aortic valve replacement (AVR). In patients less than 80 years old, it is crucial to correctly position the new valve leaving a feasible and easy access to coronary ostia, both for future percutaneous coronary intervention (PCI) than for a future possible TAVinTAV procedure. We report a 71 year old man with prior AVR presented with structural valve deterioration (SVD) leading to severe aortic stenosis. In order to guarantee comfortable coronary access we aligned, the commissures of the new percutaneous valve with the ones of the surgical bioprothesis by reconstructing the headframes of the surgical bioprosthesis with computer tomography (CT) and fluoro-CT.

scholarly journals Repeated transcatheter aortic valve implantation for the treatment of a degenerated transcatheter aortic valve implantation valve (valve-in-valve technique): a case report

2020 ◽  
Author(s):  
Vassileios Voudris ◽  
Ioannis Iakovou ◽  
Ilias Kosmas ◽  
Eftychia Sbarouni
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Risk Scores ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Valve In Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Valve-in-valve transcatheter aortic valve implantation (TAVI) has emerged as a competent alternative for the treatment of degenerated bioprosthetic valves after surgical aortic valve replacement, or during TAVI procedure as a bailout option. Herein, we report a rare case of a self-expandable Medtronic Evolut R valve into a failing Medtronic CoreValve, with the use of modern pre-TAVI imaging screening, suggesting the proper procedural design steps for so complicated implantations. Case summary A frail 78-year-old woman with a degenerated Medtronic Core Valve 26 mm bioprosthesis, implanted in 2011 due to severe aortic stenosis, was referred to our hospital due to worsening dyspnoea New York Heart Association III. The screening echocardiography documented severe aortic stenosis, while the classical risk scores were in favour of repeated TAVI (EuroSCORE II 5.67%). Computed tomography measurements and three-dimensional (3D) printing model were of great help for the proper valve selection (Medtronic Evolut R 26 mm), while the use of cerebral protection device (Claret Sentinel) was considered as a necessary part of the procedure. The simultaneous use of fluoroscopy and transoesophageal echocardiogram led to optimal haemodynamic result, confirmed by the discharge echocardiogram, with a significant clinical improvement during the first month follow-up. Discussion The main periprocedural concerns remain valve malpositioning, coronary artery obstruction, and high remaining transvalvular gradients. The multimodality pre-TAVI imaging screening may be helpful for precise procedural design. Despite the limited use of 3D models, it is necessary to adopt such tissue-mimicking phantoms to increase the possibility of optimal procedural result.

scholarly journals Case Report: Lithoplasty-Assisted Trans-Axillary Transcatheter Aortic Valve-in-Valve Implantation

2021 ◽  
Vol 8 ◽  
Author(s):  
Alfredo Giuseppe Cerillo ◽  
Matteo Pennesi ◽  
Luisa Iannone ◽  
Giorgia Giustini ◽  
Paolo de Cillis ◽  
...  
Keyword(s):  
Case Report ◽  
Aortic Valve ◽  
Clinical Assessment ◽  
Symptomatic Patient ◽  
Access Route ◽  
Transcatheter Aortic Valve ◽  
Valve In Valve ◽  
Transcatheter Valve ◽  
Valve Implantation ◽  
Selection Of

We present the case of a severely symptomatic patient with a malfunctioning aortic bioprosthesis and severe multidistrict atherosclerosis that was addressed to our unit for transcatheter valve-in-valve implantation. The imaging and clinical assessment that led to the selection of the access route is discussed.

scholarly journals A Glimpse into the Future: In 2020, Which Patients will Undergo TAVI or SAVR?

2017 ◽  
Vol 12 (01) ◽  
pp. 44 ◽  
Author(s):  
Crochan J O’sullivan ◽  
Peter Wenaweser ◽  
◽  
◽  
Keyword(s):  
Aortic Valve ◽  
Heart Valves ◽  
Severe Aortic Stenosis ◽  
Vascular Complications ◽  
Surgical Aortic Valve Replacement ◽  
Operator Experience ◽  
First Line Therapy ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) has evolved into a safe and effective procedure to treat symptomatic patients with severe aortic stenosis (AS), with predictable and reproducible results. Rates of important complications such as vascular complications, strokes and paravalvular leaks are lower than ever, because of improved patient selection, systematic use of multidector computer tomography, increasing operator experience and device iteration. Accumulating data suggest that transfemoral TAVI with newer generation transcatheter heart valves and delivery systems is superior to conventional surgical aortic valve replacement among intermediate- and high-risk patients with severe symptomatic AS with regard to all-cause mortality and stroke. One can anticipate that by 2020, the majority of patients with severe symptomatic AS will undergo TAVI as first line therapy, regardless of surgical risk.

scholarly journals Balloon- or Self-Expandable TAVI: Clinical Equipoise?

2015 ◽  
Vol 10 (2) ◽  
pp. 103 ◽  
Author(s):  
Jose John ◽  
Richardt Gert ◽  
Abdel-Wahab Mohamed ◽  
◽  
◽  
...  
Keyword(s):  
Aortic Valve ◽  
Severe Aortic Stenosis ◽  
Current Data ◽  
Clinical Equipoise ◽  
Surgical Aortic Valve Replacement ◽  
Effective Treatment Option ◽  
Transcatheter Aortic Valve ◽  
High Surgical Risk ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) has become an effective treatment option for patients with severe aortic stenosis and high surgical risk or contraindications for surgical aortic valve replacement. Most of the currently available prostheses employ either balloon-expandable or self-expandable designs. Presently, there is a paucity of data directly comparing these two widely used prosthesis types. Forthcoming trials will reveal whether newer designs of both technologies translate into fewer complications and better outcomes, with expansion of TAVI indications. This manuscript reviews features and clinical outcomes of balloon- and self-expanding prostheses, summarising current data from registries and trials.

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