Delayed prosthesis malposition after transcatheter aortic valve implantation causing coronaries obstruction

Nappi, Francesco; Spadaccio, Cristiano; Sablayrolles, Jean‐Louis

doi:10.1093/ejcts/ezx266

Cited by 10 publications

(15 citation statements)

References 5 publications

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“…Despite these precautions, two patients with TAVR‐H developed late PVL and ultimately, proximal device migration. Device migration should be a clinical rarity 21 that occurs primarily perioperatively with an incidence of approximately 1% 22 . The use of self‐expanding, first‐generation, and resheathable devices, higher cover index, sizing error, larger aortic root dimensions, and the presence of bicuspid aortic valve all predispose to device migration, but were not the cause of migration in our two patients.…”

Section: Discussionmentioning

confidence: 77%

Unique technical challenges in patients undergoing TAVR for failed aortic homografts

et al. 2020

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Objective: Surgical reoperation for aortic homograft structural valve degeneration (SVD) is a high-risk procedure. Transcatheter aortic valve replacement (TAVR) for homograft-SVD is an alternative to reoperation, but descriptions of implantation techniques are limited. This study compares outcome in patients undergoing into two groups by the type of previously implanted aortic valve prosthesis: TAVR for failed aortic homografts (TAVR-H) or for stented aortic bioprostheses (TAVR-BP). Methods: From 2015 to 2017, TAVR was performed in 41 patients with SVD. Thirty-three patients in the TAVR-BP group (six for SVD of valved conduits), and eight patients in the TAVR-H group. The Valve Academic Research Consortium criteria were used for outcome reporting purposes. Results: The patients with TAVR-BP had predominant prosthetic stenosis (94%, p = .002), whereas TAVR-H individuals presented mostly with regurgitation (88%, p = <.001). Patients with TAVR-H received: Sapien-3 (6), Sapien-XT (1), and CoreValve (1) devices. Low, 40% ventricular fixation in relation to homograft annulus was attempted to anchor the prosthesis on the homograft sutureline. One patient with TAVR-BP experienced intraoperative distal prosthesis migration and Type-B aortic dissection, and two patients in the TAVR-H group had late postoperative proximal device migration. In both groups, there was zero 30-day mortality, stroke, or pacemaker implantation. Conclusions: TAVR for failing aortic homografts may be a feasible and safe alternative to high-risk surgical reintervention. Precise, 40%-ventricular device positioning appears crucial for prevention of late paravalvular leak/late prosthesis migration and minimizing the risk of repeat surgical intervention.

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Section: Discussionmentioning

confidence: 77%

Unique technical challenges in patients undergoing TAVR for failed aortic homografts

et al. 2020

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“…The use of the MitraClip procedure is recommended in patients with disproportionate secondary mitral regurgitation in which severe MR is coupled with nonseverely dilated left ventricular chambers [95,96]. Although this new framework is a very attractive proposal, however, it does not find unanimous consensus and requires further deep investigation involving transcatheter heart valve therapy [113][114][115][116][117][118][119][120][121][122][123][124][125][126][127].…”

Section: Discussionmentioning

confidence: 99%

Exploring the Operative Strategy for Secondary Mitral Regurgitation: A Systematic Review

Nappi

Singh

Bellomo

et al. 2021

BioMed Research International

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Background. Mitral valve disease surgery is an evolving field with multiple possible interventions. There is an increasing body of evidence regarding the optimal strategy in secondary mitral regurgitation where the pathology lies within the ventricle. We conducted a systematic review to identify the benefits and limitations of each surgical option. Methods. A systematic review of the literature was performed to identify pertinent randomized controlled trials (RCTs), propensity-matched observational series, and meta-analyses which were considered initially and followed by unmatched observational series using the MEDLINE, Ovid EMBASE, and Cochrane Library. Results. We identified 6 different strategies for treating secondary mitral valve regurgitation: mitral valve replacement, restrictive mitral annuloplasty, surgical revascularization (with and without mitral annuloplasty), subvalvular procedures (papillary muscle approximation, papillary muscle relocation, ring and string procedure), and procedures directly targeting the mitral valve (edge-to-edge repair and anterior leaflet enlargement) alongside transcatheter heart valve therapy. We also highlighted the role of left ventricular assist devices in the management of this condition. The benefits and limitations of each intervention are highlighted. Conclusion. There is currently no unanimous and shared strategy for the optimal treatment of patients with secondary IMR. The management of patients with secondary mitral regurgitation must be entrusted to a multidisciplinary Heart Team to ensure ideal intervention and patient matching for the best outcomes.

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“…Therefore, its application can lead to the development of predictive models useful for the understanding of the thrombotic process and TAVR functionality in a complex structure such as the aortic root. Mechanical stress can induce remodeling phenomena in the aortic root that can lead to changes in the morphology of the wall [59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75].…”

Section: 4mentioning

confidence: 99%

Percutaneous versus Surgical Intervention for Severe Aortic Valve Stenosis: A Systematic Review

Iervolino

Singh

Nappi

et al. 2021

BioMed Research International

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Aortic stenosis is a disease that is increasing in prevalence and manifests as decreased cardiac output, which if left untreated can result in heart failure and ultimately death. It is primarily a disease of the elderly who often have multiple comorbidities. The advent of transcatheter aortic valve therapies has changed the way we treat these conditions. However, long-term results of these therapies remain uncertain. Recently, there has been an increasing number of studies examining the role of both surgical aortic valve replacement and transcatheter aortic valve replacement. We therefore performed a systematic review using Ovid MEDLINE, Ovid Embase, and the Cochrane Library. Two investigators searched papers published between January 1, 2007, and to date using the following terms: “aortic valve stenosis,” “aortic valve operation,” and “transcatheter aortic valve therapy.” Both strategies in aortic stenosis treatment highlighted specific indications alongside the pitfalls such as structural valve degeneration and valve thrombosis which have a bearing on clinical outcomes. We propose some recommendations to help clinicians in the decision-making process as technological improvements make both surgical and transcatheter therapies viable options for patients with aortic stenosis. Finally, we assess the role of finite element analysis in patient selection for aortic valve replacement. THVT and AVR-S are both useful tools in the armamentarium against aortic stenosis. The decision between the two treatment strategies should be best guided by a strong robust evidence base, ideally with a long-term follow-up. This is best performed by the heart team with the patient as the center of the discussion.

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Delayed prosthesis malposition after transcatheter aortic valve implantation causing coronaries obstruction

Cited by 10 publications

References 5 publications

Unique technical challenges in patients undergoing TAVR for failed aortic homografts

Unique technical challenges in patients undergoing TAVR for failed aortic homografts

Exploring the Operative Strategy for Secondary Mitral Regurgitation: A Systematic Review

Percutaneous versus Surgical Intervention for Severe Aortic Valve Stenosis: A Systematic Review

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