Bailout surgical explantation of a transcatheter valve-in-valve for subacute thrombosis: When there is no time for anticoagulation

Notaristefano, Francesco; Reccia, Matteo Rocco; Notaristefano, Salvatore; Annunziata, Roberto; Sclafani, Rocco; Ambrosio, Giuseppe; Cavallini, Claudio

doi:10.1016/j.carrev.2017.12.005

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…As for previous TAVR valve explant and recommended surgical technique in the literature, we have identified 11 case reports that involved description of valve explant technique from 2008 to 2019. 4,10,[15][16][17][18][19][20][21][22][23] The time interval between TAVR implant and explant was from immediate to 7 years (median 187 days; IQR, 21-913 days). Surgical explantation of older TAVR valve cases are increasingly reported recently, being exclusively after 2015.…”

Section: Discussionmentioning

confidence: 99%

Surgical explantation of transcatheter aortic bioprostheses: Results and clinical implications

Fukuhara¹,

Brescia²,

Shiomi³

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionmentioning

confidence: 99%

Surgical explantation of transcatheter aortic bioprostheses: Results and clinical implications

Fukuhara¹,

Brescia²,

Shiomi³

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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“…Common indications previously reported in case series for TAV explantation were PV leaks with explantation occurring 60 days to 7 years after the index TAVR, [14][15][16][17] infective endocarditis with explantation after 10 months to 2 years, 18-20 valve thrombosis with explantation 13−60 days after implantation, 16,[21][22][23] leaflet perforation, 24 and coronary obstruction. 25,26 Furthermore, overall mortality rates after TAV explantation have been previously reported, ranging from 15% to 22.9%, and occurring 30 days to 1-year post-TAVR.…”

Section: Discussionmentioning

confidence: 99%

Macroscopic and microscopic features of surgically explanted transcatheter aortic valve prostheses

Guimaron

Kalavrouziotis

Maranda‐Robitaille

et al. 2022

Journal of Cardiac Surgery

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Objectives: With the extended indications of transcatheter aortic valve (TAV) replacement (TAVR) to lower-risk patients, there is an increasing number of patients requiring surgical explantation of failed TAV. We sought to describe macroscopic and microscopic features of surgically explanted percutaneous aortic valve prostheses.Methods: Preoperative and surgical characteristic of patients undergoing surgical explantation of TAV were retrospectively analyzed from 2007 to 2020. Surgical and pathologic features of these valves, and outcomes of the surgical valve replacement were described.Results: Out of 1764 patients who underwent a TAVR procedure, 21 were operated for TAV failure. Isolated or combined indications for surgery included: significant paravalvular leak (n = 15), delayed prosthesis migration (n = 5), significant increase of trans-TAV gradients (n = 6), and endocarditis (n = 3). Mean time elapsed between TAVR and explantations was 674.9 ± 803.9 days. Macroscopic lesions found on explanted percutaneous valves were severe adhesions to the aorta (n = 10), calcifications (n = 7), leaflet thrombosis (n = 4), and vegetations (n = 3). Except for patients with endocarditis, one or more pathological lesions were found in 15 patients. Pathology analyses on these valves showed fibro-calcific degenerations (n = 12), pannus formation (n = 9), and chronic inflammation (n = 3). One patient (4.8%) died after surgical explantation, and 13 (61.9%) had concomitant procedures.The survival rate at 1 year was 94.4%.Conclusions: Microscopic findings of fibro-calcific leaflet degeneration, and pannus formation in addition to macroscopic calcification and thrombosis present early, (within a mean of 2 years) after TAVR. Further investigation with a higher number of patients and echocardiographic follow-up is warranted.

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“…Whether this result is permanent has to be closely evaluated in sequential examinations. Furthermore, accelerated degeneration and valve thrombosis have to be taken into consideration, since these risks are described after ViV procedures, and may be even more immanent in a ViV‐in‐valve configuration …”

Section: Discussionmentioning

confidence: 99%

Valve‐in‐valve‐in‐valve: Balloon expandable transcatheter heart valve in failing self‐expandable transcatheter heart valve in deteriorated surgical bioprosthesis

Schaefer

Conradi

Schäfer

2018

Cathet Cardio Intervent

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Valve-in-valve (ViV) procedures for failing bioprostheses carry a certain risk for device malfunction. We herein report a case of a failing Evolut R in a deteriorated Mitroflow, treated with a Sapien 3. An 81 year old female patient received surgical aortic valve replacement and was treated by ViV due to deterioration. Three years later, echocardiography revealed a pressure gradient of peak/mean 105/63 mmHg. Subsequently, a second ViV procedure with initial intentional rupture of the bioprosthetic stent was performed. Immediate stent recoil of the Evolut R prompted implantation of a Sapien 3. In 30-day follow-up, mean pressure gradient of 30 mmHg and nearly complete symptom relief was documented. Fracture of a surgical bioprosthetic stent is feasible in a ViV configuration. Supra-annular placement of a balloon-expandable THV as ViV-in-valve is feasible with suboptimal hemodynamic results in this case. Risk of re-do surgery should be weighted against anticipated hemodynamic and clinical results.

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Bailout surgical explantation of a transcatheter valve-in-valve for subacute thrombosis: When there is no time for anticoagulation

Cited by 4 publications

References 10 publications

Surgical explantation of transcatheter aortic bioprostheses: Results and clinical implications

Surgical explantation of transcatheter aortic bioprostheses: Results and clinical implications

Macroscopic and microscopic features of surgically explanted transcatheter aortic valve prostheses

Valve‐in‐valve‐in‐valve: Balloon expandable transcatheter heart valve in failing self‐expandable transcatheter heart valve in deteriorated surgical bioprosthesis

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