Mixed aortic valve disease treated with transcatheter aortic valve replacement in a high risk patient presenting with acute decompensated heart failure

2019 ◽  
Vol 94 (2) ◽  
pp. 296-300
Author(s):  
Leah Raj ◽  
Anilkumar Mehra ◽  
David M. Shavelle
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Aortic Valve Disease ◽  
Acute Decompensated Heart Failure ◽  
High Risk Patient ◽  
Decompensated Heart Failure ◽  
Transcatheter Aortic Valve

Direct Transcatheter Valve Deployment via Sternotomy for Complex Aortic Valve Reoperation

2019 ◽  
Vol 14 (4) ◽  
pp. 365-368
Author(s):  
Tom C. Nguyen ◽  
Alexander P. Nissen ◽  
Pranav Loyalka ◽  
Eyal E. Porat
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
High Risk Patient ◽  
Direct Vision ◽  
Risk Patient ◽  
Transcatheter Aortic Valve ◽  
Valve In Valve

Reoperative aortic valve replacement is associated with increased morbidity. Valve-in-valve transcatheter aortic valve replacement offers a less invasive alternative to traditional reoperation. However, cases of valve failure after valve-in-valve transcatheter aortic valve replacement represent a complex surgical challenge. We present a case requiring a complex reoperative aortic valve replacement due to structural valve deterioration after multiple previous valve-in-valve transcatheter aortic valve replacements. We performed removal of 3 previous valve-in-valve transcatheter aortic valves, bioprosthetic leaflet excision, and intentional bioprosthetic fracture under direct vision for annular enlargement. This facilitated direct insertion of a new transcatheter aortic valve for expedient and successful management of recurrent aortic stenosis in a very high-risk patient. Creative use of leaflet excision, intentional bioprosthetic fracture, and insertion of a new transcatheter aortic valve under direct vision, proved efficient and successful in a high-risk patient with few surgical options.

Transcatheter Aortic Valve Replacement (TAVR) and Angioplasty in a High-Risk Patient

2018 ◽  
pp. 235-246
Author(s):  
Flávia Cristina Kufner ◽  
Carlos Henrique Romancini ◽  
Caroline Kelli Domingues dos Santos ◽  
Evandro Luis Queiroz Flores ◽  
Rui M. S. Almeida
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
High Risk Patient ◽  
Risk Patient ◽  
Transcatheter Aortic Valve

scholarly journals Transcatheter aortic valve replacement for bicuspid aortic valve regurgitation in a 17-year-old patient with congenitally corrected transposition of great arteries: a case report

2020 ◽  
Vol 4 (3) ◽  
pp. 1-6 ◽  
Author(s):  
Takahiro Nomura ◽  
Masaki Miyasaka ◽  
Evan M Zahn ◽  
Raj R Makkar
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Transposition Of Great Arteries ◽  
Transcatheter Aortic Valve ◽  
Congenitally Corrected Transposition ◽  
Corrected Transposition

Abstract Background Limited research has been conducted on the surgical management of the aortic valve in congenitally corrected transposition of great arteries (ccTGA) and to our knowledge there have been no reports on the treatment of bicuspid aortic regurgitation (AR) in ccTGA. We report on a ccTGA patient with bicuspid AR and systemic right ventricule (SRV) dysfunction who underwent transcatheter aortic valve replacement (TAVR). Case summary A 17-year-old male with a history of ccTGA and cerebral palsy diagnosed at birth presented with heart failure. During childhood, he did not experience any heart failure symptoms, however, secondary to progressive bicuspid AR he experienced worsening SRV dysfunction beginning at 15-year-old. Echocardiography showed reduced SRV ejection fraction and severe bicuspid AR. The heart team, including a cardiac surgeon and paediatric cardiologist, discussed the treatment strategies and decided to proceed with TAVR as surgical aortic valve replacement was deemed high risk. TAVR was performed with the 34 mm Evolut R (Medtronic, Minneapolis, MN, USA). Post-operative echocardiography showed severe paravalvular leak (PVL). Therefore, valve-in-valve TAVR using a 29 mm Edwards SAPIEN 3 (Edwards Lifesciences, Irvine, CA, USA) was performed on post-operative Day 2 for PVL reduction. Following second procedure, PVL was significantly improved. The patient was discharged in stable condition. Discussion This is the first case wherein TAVR was performed for bicuspid AR in a patient with ccTGA. With appropriate preparation and planning and a collaborative multi-disciplinary team approach, TAVR can be a treatment option for severe AR in patients with ccTGA at high risk for surgery.

scholarly journals Outcomes of Emergency Transcatheter Aortic Valve Replacement

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Hans Huang ◽  
Christopher P. Kovach ◽  
Sean Bell ◽  
Mark Reisman ◽  
Gabriel Aldea ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Decompensated Heart Failure ◽  
Circulatory Support ◽  
Transcatheter Aortic Valve

Objective. To identify outcomes of patients undergoing emergency transcatheter aortic valve replacement (TAVR) and determine predictors of in-hospital mortality. Background. Emergency TAVR has emerged as a viable treatment strategy for patients with decompensated severe aortic stenosis and/or regurgitation; however, data on patients undergoing emergency TAVR are limited. Methods. All emergency TAVR procedures were identified from a single tertiary academic center between January 2015 and August 2018. Results. 31 patients underwent emergency TAVR due to cardiogenic shock (26 patients), electrical instability with incessant ventricular tachycardia (2 patients), severe refractory angina (2 patients), and decompensated heart failure with hypoxemic respiratory failure requiring mechanical ventilation (1 patient). Mechanical circulatory support (MCS) was used in 16 (51.6%). MCS initiation occurred immediately prior to TAVR in 10 patients and placed post-TAVR in 6 patients. 6 patients died before hospital discharge (in-hospital mortality 19.4%). 1-year and 2-year survival rates were 61.0% and 55.9%, respectively. Univariate predictors of in-hospital mortality were preprocedural pulmonary artery pulsatility index (PAPi) ≤1.8 (66.7% vs. 20.0%, p=0.01), intraprocedural cardiopulmonary resuscitation (CPR) (83.3% vs 4.0%, p≤0.001), acute kidney injury post-TAVR (80.0% vs. 4.2%, p≤0.001), initiation of dialysis post-TAVR (60.0% vs. 4.2%, p≤0.001), and MCS initiation post-TAVR (50.0% vs. 12.0%, p=0.03). MCS initiation before TAVR was associated with improved survival compared with post-TAVR initiation. Conclusion. Emergency TAVR in extreme risk patients with acute decompensated heart failure or cardiogenic shock secondary to severe aortic valve disease is associated with high in-hospital mortality rates. Careful patient selection taking into account right heart function, assessed by PAPi, and early utilization of MCS may improve survival following emergency TAVR.

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