Transcatheter Aortic Valve Replacement in a Young Adult Patient with a Failed Homograft

Hoyt, Walter J.; Ailawadi, Gorav; Mulloy, Daniel P.; Ghanta, Ravi K.; Ragosta, Michael; Lim, D. Scott

doi:10.1007/s00246-016-1399-2

Cited by 4 publications

(6 citation statements)

References 18 publications

(17 reference statements)

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“…6 However, clinical experience is still comparatively minimal, and long-term follow-up data are needed to establish the clinical usefulness of valve-in-valve implantation for treating homograft degeneration. 1,3,4 In our patient, a 4th open AVR would have been prohibitively risky. Pending the results of long-term follow-up studies and more experience, we think that similar young patients who have undergone multiple valve replacements might benefit from TAVR.…”

Section: Discussionmentioning

confidence: 70%

“…7 The number of patients referred for valve-in-valve replacement of degenerated bioprosthetic aortic valves is rapidly increasing. 4,6 The feasibility of percutaneous or minimally invasive valve-in-valve placement of the Edwards Sapien valve into failing aortic root homografts-an off-label use-has been discussed in a few case reports. 1,3,4 With the use of the radiopaque Edwards Sapien bioprosthesis, valve-in-valve replacement can be comparatively simple.…”

Section: Discussionmentioning

confidence: 99%

“…4,6 The feasibility of percutaneous or minimally invasive valve-in-valve placement of the Edwards Sapien valve into failing aortic root homografts-an off-label use-has been discussed in a few case reports. 1,3,4 With the use of the radiopaque Edwards Sapien bioprosthesis, valve-in-valve replacement can be comparatively simple. We used the transapical approach because the direct access enabled optimal coaxial alignment and positioning of the new valve within the degenerated homograft; this transapical approach was first reported by Attia and colleagues 8 to treat a patient who had a degenerated bioprosthesis.…”

Section: Discussionmentioning

confidence: 99%

“…6 As a derivation of this approach, TAVR has been used in a few instances of degenerated homografts. 1,3,4 We report a case of TAVR in a young adult who had previously undergone 3 open AVRs and who presented with severe calcific homograft stenosis.…”

mentioning

confidence: 99%

“…Aortic root homografts are rarely used; thus, few data are available to determine the ideal method for repeat homograft replacement. [1][2][3][4] Transcatheter aortic valve replacement (TAVR) is a well-established treatment for elderly patients who have severe, symptomatic aortic stenosis and who are at high surgical risk. 5 Because this treatment's long-term results are unknown, some cardiac surgeons and interventional cardiologists think that TAVR should be reserved for older patients or those with short life expectancies.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Transcatheter Aortic Valve-in-Valve Replacement Instead of a 4th Sternotomy in a 21-Year-Old Woman with Aortic Homograft Failure

Díez¹,

Schechter²,

Dougherty³

et al. 2016

Texas Heart Institute Journal

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Transcatheter aortic valve replacement (TAVR) is a well-established method for replacing native aortic valves; however, it was conceived for elderly patients with aortic valve stenosis, and the lack of data on long-term durability has led practitioners to restrict the use of TAVR to patients who have short life expectancies. Here, we describe the case of a 21-year-old woman who had undergone 3 previous open aortic valve replacements and who presented with symptoms of recurrent valvular failure. Transthoracic echocardiograms and computed tomographic angiograms revealed a degenerating aortic root homograft with substantial calcification, moderate-to-severe aortic valve stenosis, and severe aortic valve regurgitation. Open surgical valve replacement posed substantial risk to our patient, so we decided to perform valve-in-valve TAVR with use of the Edwards Sapien XT Transcatheter Heart Valve. The patient's pulmonary artery pressure, valvular regurgitation, and symptoms improved substantially thereafter. We found that valve-in-valve TAVR into a failing aortic root homograft was less invasive than repeat surgical valve replacement in this young patient who had congenital vascular anomalies and a complex surgical history.

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Section: Discussionmentioning

confidence: 70%