Transcatheter heart valve in valve implantation with Edwards SAPIEN bioprosthetic valve for different degenerated bioprosthetic valve positions (First Iranian ViV report with mid-term follow up)

Abstract

Introduction: After early successful experience with transcatheter aortic valve replacement (TAVR), concept of transcatheter implantation of a new valve within a failing bioprosthetic valve emerged. Valve-in-valve (ViV) implantation seems to be a simpler option for high risk surgical patients. Methods: We performed five ViV procedures in different valve positions. We included patients with failing bioprosthetic valves with high surgical risk due to concomitant comorbidities. We performed 2 transapical ViV procedures for failing mitral bioprosthetic valves, 1 transfemoral procedure for failing pulmonary valve and 2 transfemoral ViV implantation for failing tricuspid bioprosthetic valves. Results: The procedures were successfully completed in all 5 cases with initial excellent fluoroscopic and echocardiographic verification. There was no valve embolization or paravalvular leakage in any of the cases. Transcatheter valve function was appropriate with echocardiography. Post procedural clinical adverse events like pleural effusion and transient ischemic attack were managed successfully. In midterm follow up all cases remained in appropriate functional class except from the transcatheter pulmonary valve which became moderately stenotic and regurgitant. Conclusion: As the first Iranian all-comers case series with midterm follow up for ViV implantation, we had no mortality. Interestingly none of our patients had neurologic sequelae after the procedure. Midterm follow up for our patients was acceptable with good functional class and appropriate echocardiographic findings. Due to high surgical risk of the redo procedure after failing of a bioprosthetic valve especially in elderly patients with comorbidities, ViV implantation would be a good alternative to surgery for this high risk group.

Mid to Long-term Echocardiographic Follow-up of Patients Undergoing Transcatheter Tricuspid Valve-in-Valve Replacement for Degenerated Bioprosthetic Valves: First Single-Center Report from Iran

“…The first data of transcatheter valve-in-valve procedure in Iran was reported by Haji Zeinali et al, 17 who showed acceptable midterm results after the valve-in-valve treatment of different failing bioprosthetic valves (2 mitral, 1 pulmonary, and 2 tricuspid valves) in a case series of 5 patients. The patients had manageable postprocedural complications, including pleural effusions and transient ischemic attacks; furthermore, at follow-up, the patients had improved NYHA functional class without paravalvular leakage or valve thrombosis.…”

Assessment of Complex Multi-Valve Disease and Prosthetic Valves

“…In the Echo assessment of multiple prostheses, the use of multiple and sometimes off-axis views is crucial to overcome the problem of acoustic shadowing, reverberations and mirror artefacts that are more pronounced for mechanical valves. Besides the classical mechanical and bioprosthetic valves, a steady increase in the number of percutaneous procedures is seen each year [64], including the complex transcatheter valve-in-valve and valve-in ring implantations in patients with documented prosthetic valve dysfunction [65]. More long-term outcome data are required in transcatheter aortic and mitral valve interventions which still carry significant peri-procedural risks and often leave varying degrees of residual paravalvular regurgitation [49,62,64].…”