scholarly journals Optimising the Haemodynamics of Aortic Valve-in-valve Procedures

2017 ◽  
Vol 12 (01) ◽  
pp. 40 ◽  
Author(s):  
Ren Jie Yao ◽  
Matheus Simonato ◽  
Danny Dvir ◽  
◽  
◽  
...  
Keyword(s):  
Aortic Valve ◽  
Heart Valve ◽  
Standard Of Care ◽  
Common Adverse Event ◽  
Mechanical Valves ◽  
Transcatheter Heart Valve ◽  
Implantation Depth ◽  
Valve In Valve ◽  
Transcatheter Valve ◽  
Valve Implantation

Bioprosthetic surgical valves are increasingly implanted during cardiac surgery, instead of mechanical valves. These tissue valves are associated with limited durability and as a result transcatheter valve-in-valve procedures are performed to treat failed bioprostheses. A relatively common adverse event of aortic valve-in-valve procedures is residual stenosis. Larger surgical valve size, supra-annular transcatheter heart valve type, as well as higher transcatheter heart valve implantation depth, have all been shown to reduce the incidence of elevated post-procedural gradients. With greater understanding of technical considerations and surgical planning, valve-invalve procedures could be more effective and eventually may become the standard of care for our increasingly ageing and comorbid population with failed surgical bioprostheses.

scholarly journals First-in-Human Use of the Next-generation ProtEmbo Cerebral Embolic Protection System During Transcatheter Aortic Valve-in-valve Implantation

2021 ◽  
Vol 16 (Supplement 1) ◽  
pp. 1-4
Author(s):  
Dariusz Jagielak ◽  
Radoslaw Targonski ◽  
Dariusz Ciecwierz
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Aortic Regurgitation ◽  
Heart Valve ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Valve In Valve ◽  
Human Use ◽  
Valve Implantation

Cerebral embolic protection (CEP) devices aim to reduce the risk of periprocedural cerebrovascular events during transcatheter aortic valve implantation (TAVI). Here, the authors describe the first-in-human experience with the ProtEmbo Cerebral Protection System (Protembis), a next-generation CEP device, during TAVI. This case is part of a larger European trial evaluating the safety and performance of this device. After deployment of the ProtEmbo in the aortic arch, a first transcatheter heart valve was implanted. Despite postdilatation, moderate to severe aortic regurgitation persisted. The operating team decided to perform a valve-in-valve procedure using a second transcatheter heart valve. The ProtEmbo demonstrated good coverage of all three head vessels and no interaction with TAVI catheters in the aortic arch throughout the entire procedure. No adverse events were observed during hospitalisation or follow-up, and there was a significant reduction in aortic regurgitation at follow-up echocardiography. Despite a challenging overall procedure with presumably high embolic burden, diffusion-weighted MRI at follow-up showed a low number (n=3) and volume (156 mm3) of new hyperintense lesions. The first-in-human use of the ProtEmbo was safe and feasible, despite a challenging TAVI valve-in-valve procedure.

scholarly journals Bioprosthetic Aortic Valve Fracture During Valve-in-valve Transcatheter Aortic Valve Implantation

2019 ◽  
Vol 14 (3) ◽  
pp. 147-151 ◽  
Author(s):  
John Phineas O’Donnell ◽  
Cróchán J O’Sullivan
Keyword(s):  
Aortic Valve ◽  
Heart Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Great Promise ◽  
Ageing Population ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Valve In Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

The limited durability of surgical bioprostheses, combined with an ageing population, has led to an increasing demand for replacing degenerated bioprosthetic surgical heart valves, which is projected to increase. Valve-in-valve transcatheter aortic valve implantation involves implanting a transcatheter heart valve within a degenerated bioprosthetic surgical heart valve. A significant minority of patients, however, are left with a suboptimal haemodynamic result with high residual gradients. This is more common with smaller surgical bioprostheses, and may be associated with a worse prognosis. The novel concept of fracturing the previously implanted bioprosthetic surgical heart valve during valve- in-valve transcatheter aortic valve implantation to create a more favourable haemodynamic profile has shown great promise, particularly in smaller valves. Herein, we describe the benefits, limitations and potential complications of this novel approach.

scholarly journals Allegra Transcatheter Heart Valve inside a Degenerated Sutureless Aortic Bioprosthesis

2021 ◽  
Vol 10 (01) ◽  
pp. e1-e5
Author(s):  
Maximilian Vondran ◽  
Bernd Abt ◽  
Holger Nef ◽  
Ardawan J. Rastan
Keyword(s):  
Aortic Valve ◽  
Heart Valve ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Valve In Valve ◽  
Valve Implantation

AbstractTranscatheter aortic valve-in-valve implantation (VIV) is increasingly being used to successfully treat degenerated surgical aortic valve bioprostheses (SAVs). The new self-expanding transcatheter heart valve Allegra, from New Valve Technology with its special implantation mechanism, has proven its safety and feasibility for patients with degenerated SAVs, but it has never been used in the latest-generation sutureless SAV. To the best of our knowledge, this is the first description of the successful VIV of the Allegra prosthesis into a degenerated sutureless SAV, and the procedure yielded an excellent postinterventional hemodynamic results.

scholarly journals FATAL CARDIOVASCULAR COLLAPSE DURING TRANS-AORTIC TRANSCATHETER AORTIC VALVE REPLACEMENT FOLLOWING INTRA-PROCEDURAL RETROGRADE TRANSCATHETER HEART VALVE MIGRATION INTO THE LEFT VENTRICULAR OUTFLOW TRACT

2021 ◽  
pp. 69-75
Author(s):  
Pankaj Jariwala ◽  
Kartik Pandurang Jadhav ◽  
Satya Sridhar Kale ◽  
Lakshmana Sepur
Keyword(s):  
Aortic Valve ◽  
Heart Valve ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Left Ventricular Outflow ◽  
And Migration ◽  
Transcatheter Valve ◽  
Valve Implantation

Transcatheter heart valve retrograde migration after transcatheter aortic valve implantation is unusual. It can occur during the implantation of the aortic transcatheter heart valve, i.e., intra-procedural, or in the first few days following the intervention. Transcatheter valve embolisation and migration soon after deployment typically results from the implantation of a prothesis that was undersized for the annulus, an unreasonably low implantation, or the expulsion of the device following deployment by an excessive ventricular contraction. The presented case highlights the importance of the timing of the complication that has taken place, in this case, intra-procedural, which has become relevant to the research.

scholarly journals Incidence and outcome of peri-procedural transcatheter heart valve embolization and migration: the TRAVEL registry (TranscatheteR HeArt Valve EmboLization and Migration)

2019 ◽  
Vol 40 (38) ◽  
pp. 3156-3165 ◽  
Author(s):  
Won-Keun Kim ◽  
Ulrich Schäfer ◽  
Didier Tchetche ◽  
Holger Nef ◽  
Martin Arnold ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Heart Valve ◽  
Kidney Injury ◽  
Transcatheter Aortic Valve ◽  
Cardiopulmonary Support ◽  
Transcatheter Heart Valve ◽  
And Migration ◽  
Transcatheter Valve ◽  
Valve Implantation ◽  
Major Stroke

Abstract Aims Peri-procedural transcatheter valve embolization and migration (TVEM) is a rare but potentially devastating complication of transcatheter aortic valve implantation (TAVI). We sought to assess the incidence, causes, and outcome of TVEM in a large multicentre cohort. Methods and results We recorded cases of peri-procedural TVEM in patients undergoing TAVI between January 2010 and December 2017 from 26 international sites. Peri-procedural TVEM occurred in 273/29 636 (0.92%) TAVI cases (age 80.8 ± 7.3 years; 53.8% female), of which 217 were to the ascending aorta and 56 to the left ventricle. The use of self-expanding or first-generation prostheses and presence of a bicuspid aortic valve were independent predictors of TVEM. Bail-out measures included repositioning attempts using snares or miscellaneous tools (41.0%), multiple valve implantations (83.2%), and conversion to surgery (19.0%). Using 1:4-propensity matching, we identified a cohort of 235 patients with TVEM (TVEMPS) and 932 patients without TVEM (non-TVEMPS). In the matched cohort, all-cause mortality was higher in TVEMPS than in non-TVEMPS at 30 days (18.6% vs. 4.9%; P < 0.001) and after 1 year (30.5% vs. 16.6%; P < 0.001). Major stroke was more frequent in TVEMPS at 30 days (10.6% vs. 2.8%; P < 0.001), but not at 1 year (4.6% vs. 1.9%; P = 0.17). The need for emergent cardiopulmonary support, major stroke at 30 days, and acute kidney injury Stages 2 and 3 increased the risk of 1-year mortality, whereas a better renal function at baseline was protective. Conclusion Transcatheter valve embolization and migration occurred in approximately 1% and was associated with increased morbidity and mortality.

A valve-in-valve transcatheter aortic valve implantation with commissural alignment using advanced imaging reconstruction: a case report

2020 ◽  
Vol 3 (10) ◽  
pp. 01-05
Author(s):  
Marco Angelillis
Keyword(s):  
Aortic Valve ◽  
Severe Aortic Stenosis ◽  
Coronary Intervention ◽  
Easy Access ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Structural Valve Deterioration ◽  
Valve In Valve ◽  
Transcatheter Valve ◽  
Valve Implantation

Transcatheter valve in valve (ViV) implantation actually represents a valid alternative to surgical reinterventions in patients with previous surgical aortic valve replacement (AVR). In patients less than 80 years old, it is crucial to correctly position the new valve leaving a feasible and easy access to coronary ostia, both for future percutaneous coronary intervention (PCI) than for a future possible TAVinTAV procedure. We report a 71 year old man with prior AVR presented with structural valve deterioration (SVD) leading to severe aortic stenosis. In order to guarantee comfortable coronary access we aligned, the commissures of the new percutaneous valve with the ones of the surgical bioprothesis by reconstructing the headframes of the surgical bioprosthesis with computer tomography (CT) and fluoro-CT.

Real-World Experience With the SAPIEN 3 Ultra Transcatheter Heart Valve: A Propensity-Matched Analysis From the United States

2021 ◽  
Vol 14 (9) ◽  
Author(s):  
Tamim M. Nazif ◽  
Thomas J. Cahill ◽  
David Daniels ◽  
James M. McCabe ◽  
Mark Reisman ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Heart Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Sapien 3 ◽  
Transcatheter Valve

Background: Paravalvular regurgitation (PVR) after transcatheter aortic valve replacement is associated with adverse clinical outcomes. The SAPIEN 3 Ultra (Ultra) is a new generation balloon-expandable transcatheter heart valve with a modified external skirt that is designed to reduce PVR, but reports of clinical and echocardiographic outcomes are limited. The aim of this study was to compare short-term outcomes of patients undergoing transcatheter aortic valve replacement with the Ultra and the original SAPIEN 3 (S3) transcatheter heart valve in a large national registry. Methods: Data from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry was used to compare patients who underwent elective, transfemoral transcatheter aortic valve replacement with the Ultra or S3 transcatheter heart valve. Clinical and echocardiographic outcomes were analyzed in a propensity-matched cohort at discharge and 30 days. Results: Patients who underwent transcatheter aortic valve replacement with Ultra (N=1324) from January 2019 to February 2020 were propensity score–matched with patients treated with S3 (N=32 982) during the same period, resulting in 1324 matched pairs. There was no difference in the rate of device success between patients treated with Ultra and S3 (97.1% versus 98.0%, P =0.11). At hospital discharge, PVR was significantly reduced with Ultra compared with S3, with mild PVR in 9.0% versus 13.9% and moderate or greater PVR in 0.1% versus 0.4% (overall P <0.01). At 30 days, there were no differences between Ultra and S3 recipients in the rates of all-cause mortality or stroke (1.8% versus 2.8%, P =0.10), major vascular complications (1.1% versus 1.0%, P =0.84), or permanent pacemaker implantation (6.4% versus 6.2%, P =0.81). Conclusions: In this propensity-matched analysis from the Transcatheter Valve Therapy Registry, the Ultra transcatheter heart valve was associated with similar procedural and 30-day clinical outcomes, but reduced incidence of PVR, compared with S3. The clinical benefit of less PVR should be evaluated in longer-term studies.

scholarly journals Long-term Transcatheter Aortic Valve Durability

2019 ◽  
Vol 14 (2) ◽  
pp. 62-69 ◽  
Author(s):  
Giuliano Costa ◽  
Enrico Criscione ◽  
Denise Todaro ◽  
Corrado Tamburino ◽  
Marco Barbanti
Keyword(s):  
Aortic Valve ◽  
European Association ◽  
Standard Of Care ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
International Data ◽  
Valve In Valve ◽  
European Society Of Cardiology ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) has become the standard of care for high-risk and inoperable surgical patients and a valid alternative to surgery for low- and intermediate-risk patients with severe, symptomatic aortic stenosis. It is increasingly being used for younger, lower-risk patients, so it is important to ensure the durability for long-term transcatheter aortic valves. The lack of standard definitions of structural valve degeneration (SVD) had made comparison among studies on prosthetic valve durability problematic. The 2017 standardised definitions of SVD by the European Association of Percutaneous Cardiovascular Intervention), the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery, and the 2018 definitions by the Valve In Valve International Data group, has generated an increased uniformity in evaluations. This article examines the potential mechanisms and rates of SVD of transcatheter bioprostheses and the role of redo TAVI as a treatment option.

Sign in / Sign up

Export Citation Format

Share Document