scholarly journals Surgery after Failed Transcatheter Aortic Valve Implantation: Indications and Outcomes of a Concerning Condition

2021 ◽  
Vol 11 (1) ◽  
pp. 63
Author(s):  
Mohamed Salem ◽  
Christina Grothusen ◽  
Mostafa Salem ◽  
Derk Frank ◽  
Mohammed Saad ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Postoperative Outcome ◽  
Valve Prosthesis ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Study Results ◽  
History Of ◽  
Underlying Causes ◽  
Transcatheter Valve ◽  
Valve Implantation

Objectives: The number of transcatheter aortic valve implantations (TAVI) has increased enormously in recent decades. Transcatheter valve prosthesis failure and the requirement of conventional surgical replacement are expected to attract more focus in the near future. Indeed, given the scarcity of research in this field, the next decade will likely represent the beginning of a period of meaningful exploration of the degenerative changes that occur with transcatheter valves. The current study represents—through a series of consecutive cases—one of the first analyses of the underlying causes of TAVI failure, i.e., degenerative, functional and infective, followed by surgical aortic valve replacement (SAVR) and postoperative outcome. Methods: Between October 2008 and March 2021, 2098 TAVI procedures, including 1423 with transfemoral, 309 with transapical, and 366 with transaortic access, were performed in our institution. Among these, 0.5% (number(n) = 11) required acute SAVR (n = 6) within 7 days (n = 3) or later (n = 2), and were included in the study. Results: Valve stent dislocation was the most common cause of replacement (83%). Causes of replacement within 7 days after TAVI were multifactorial. In the later course, endocarditis was the sole indication for SAVR after TAVI. TAVI with transapical or transaortal approach had a higher EuroSCORE II (10.9 (7.2–35.3) vs. 3.5 (1.8–7.8)). Their 30-day mortality after surgical conversion was higher (67% vs. 20%), when compared to those who underwent a transfemoral procedure. The longest documented survival beyond 30 days was 58 months. Conclusions: The causes of SAVR after TAVI failure are multifactorial, and include biological, physical and infectious factors. An acceptable midterm prognosis may be expected in patients with physical causes when dislocation of the catheter prosthesis is observed; in such cases, emergency conversion is required. Conversion due to infection, as in cases of endocarditis, had the worst outcome. Prognosis after conversion due to degeneration is still problematic, due to a lack of autopsies and the recent history of prosthetic implantations.

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.

Antithrombotic treatment in patients undergoing transcatheter aortic valve implantation (TAVI)

2015 ◽  
Vol 113 (04) ◽  
pp. 674-685 ◽  
Author(s):  
Vincent J. Nijenhuis ◽  
Naoual Bennaghmouch ◽  
Jan-Peter van Kuijk ◽  
Davide Capodanno ◽  
Jurriën M. ten Berg
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Bleeding Complications ◽  
Valve Prosthesis ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Mitral Valve Prosthesis ◽  
Ischemic Complications ◽  
Aortic Valve Implantation ◽  
Valve Implantation

SummaryTranscatheter aortic valve implantation (TAVI) is an established treatment option for symptomatic patients with severe aortic valvular disease who are not suitable for conventional surgical aortic valve replacement. Despite improving experience and techniques, ischaemic and bleeding complications after TAVI remain prevalent and impair survival in this generally old and comorbid-rich population. Due to changing aetiology of complications over time, antiplatelet and anticoagulant therapy after TAVI should be carefully balanced. Empirically, a dual antiplatelet strategy is generally used after TAVI for patients without an indication for oral anticoagulation (OAC; e. g. atrial fibrillation, mechanical mitral valve prosthesis), including aspirin and a thienopyridine. For patients on OAC, a combination of OAC and aspirin or thienopyridine is generally used. This review shows that current registries are unfit to directly compare antithrombotic regimens. Small exploring studies suggest that additional clopidogrel after TAVI only affects bleeding and not ischemic complications. However, these studies are lack in quality in terms of Cochrane criteria. Currently, three randomised controlled trials are recruiting to gather more knowledge about the effects of clopidogrel after TAVI.

scholarly journals Transseptal transcatheter valve-in-valve implantation for failed surgical mitral bioprosthesis: the first clinical experience

2020 ◽  
Vol 24 (1) ◽  
pp. 94
Author(s):  
V. I. Ganyukov ◽  
E. A. Shloido ◽  
R. S. Tarasov ◽  
N. V. Rogulina ◽  
I. K. Khalivopulo ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Conflict Of Interest ◽  
Clinical Status ◽  
Clinical Aspects ◽  
Valve Prosthesis ◽  
Transcatheter Aortic Valve ◽  
Mitral Valve Prosthesis ◽  
Transcatheter Valve ◽  
Valve Implantation

<p>A clinical case of endovascular correction of a biological mitral valve prosthesis dysfunction by implantation of a transcatheter aortic valve into the mitral position is described. Considering the clinical status of the patient, the condition was determined to be inoperable. Subsequently, based on vital fluoroscopy and echocardiography findings, the patient was implanted with a transcatheter aortic valve in the mitral valve bioprosthesis position. The technical and clinical aspects of the intervention and its results were analysed during the hospital period and for 5 months after implantation. The selected method of treatment was found to be appropriate.</p><p>Received 10 January 2020. Revised 18 March 2020. Accepted 19 March 2020.</p><p><strong>Funding</strong>: The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Drafting the article: N.V. Rogulina, I.V. Ganyukov, A.M. Kochergina, V.I. Ganyukov, R.S. Tarasov, I.K. Khalivopulo, I.N. Sizova <br />Literature review: V.I. Ganyukov, R.S. Tarasov, N.V. Rogulina, I.K. Khalivopulo, I.V. Ganyukov, A.M. Kochergina <br />Illustrations: I.V. Ganyukov, I.N. Sizova, N.V. Rogulina <br />Critical revision of the article: V.I. Ganyukov, R.S. Tarasov, E.A. Shloido, L.S. Barbarash <br />Surgical treatment: E.A. Shloido, V.I. Ganyukov, R.S. Tarasov<br />Final approval of the version to be published: V.I. Ganyukov, E.A. Shloido, R.S. Tarasov, N.V. Rogulina, I.K. Khalivopulo, I.V. Ganyukov, A.M. Kochergina, I.N. Sizova, L.S. Barbarash</p>

Percutaneous Heart Valve Therapy – Options, Risks and Benefits

2010 ◽  
Vol 6 (1) ◽  
pp. 65
Author(s):  
Gian Paolo Ussia ◽  
Marco Barbanti ◽  
Valeria Cammalleri ◽  
Marilena Scarabelli ◽  
Massimiliano Mulè ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Valve Prosthesis ◽  
Valve Repair ◽  
Risks And Benefits ◽  
Transcatheter Aortic Valve ◽  
Effective Option ◽  
Aortic Valve Implantation ◽  
Transcatheter Valve ◽  
Percutaneous Heart Valve ◽  
Valve Implantation

Transcatheter valve therapy is emerging as an effective option for aortic valve stenosis and mitral regurgitation. In 1992, Anderson demonstrated the feasibility of percutaneous implantation of catheter-based valve prosthesis. Since then, many technical and device advances have been made, and transcatheter aortic valve implantation and mitral valve repair have became a concrete alternative to surgical replacement.

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