Repeat transcatheter aortic valve implantation using a latest generation balloon-expandable device for treatment of failing transcatheter heart valves

Abstract

BackgroundParavalvular leakage (PVL) is a known complication of transcatheter aortic valve implantation (TAVI) and is associated with poor outcome. Besides balloon-post-dilatation, valve-in-valve (ViV) procedures can be taken into consideration to control this complication. Herein we present initial experience with use of the latest generation balloon-expandable Edwards Sapien 3® (S3) transcatheter heart valve (THV) for treatment of failing THVs.MethodsBetween 01/2014 and 12/2014 three patients (two male, age: 71–80 y, log EUROScore I: 11.89 – 32.63) with failing THVs were refered to our institution for further treatment. THV approach with secondary implantation of an S3 was chosen after mutual agreement of the local interdisciplinary heart team at an interval of 533–1119 days from the index procedure. The performed procedures consisted of: S3 in Sapien XT, JenaValve and CoreValve.ResultsSuccessful transfemoral implantation with significant reduction of PVL was achieved in all cases. No intraprocedural complications occured regarding placement of the S3 with a postprocedural effective orifice area (EOA) of 1.5–2.5 cm2 and pressure gradients of max/mean 14/6–36/16 mmHg. 30-day mortality was 0 %. At the latest follow-up of 90–530 days, all patients are alive and well with satisfactory THV function. Regarding VARC-2 criteria one major bleeding and one TIA was reported.ConclusionsIn the instance of moderate or severe aortic regurgitation after TAVI, S3 ViV deployment is an excellent option to reduce residual regurgitation to none or mild. For further assertions concerning functional outcomes long-term results have to be awaited.

Outcomes of Redo Transcatheter Aortic Valve Replacement for the Treatment of Postprocedural and Late Occurrence of Paravalvular Regurgitation and Transcatheter Valve Failure

“…To date, only a few anecdotal reports have demonstrated the feasibility of this approach. [9][10][11][12] The aim of this multicenter international collaboration was to examine the safety and the midterm efficacy of redo TAVR to treat postprocedural and late transcatheter valve failure.…”

Valve-in-valve procedures for degenerated surgical and transcatheter aortic valve bioprostheses using a latest-generation self-expanding intra-annular transcatheter heart valve

“…Valve-in-valve (ViV) transfemoral (TF) transcatheter aortic valve implantation (TAVI) for failing aortic surgical bioprostheses or transcatheter heart valves (THV) has demonstrated a reasonable clinical and hemodynamic efficacy in patients not suitable for redo surgical aortic valve replacement (SAVR) ( 1 , 2 ). Therefore, this technique was implemented in international guidelines for treatment of valvular heart disease ( 3 , 4 ).…”

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

“…Furthermore low implantation height is associated with device malfunction for both BE and SE THV . Although, there are reports of failing THV in native aortic annuli with subsequent ViV in terms of transcatheter aortic valve implantation (TAVI) in TAVI, to date no ViV‐in‐valve procedures for failing THV in failing surgical bioprostheses are documented. We herein describe a case of a failing CoreValve EvolutR (Medtronic PLC, Minneapolis, MN, US) implanted in a deteriorated Mitroflow (LivaNova PLC, London, UK), which was treated with a Sapien 3 THV (Edwards Lifesciences PLC, Irvine, CA, US).…”