Use of transcatheter heart valves for a valve-in-valve implantation in patients with degenerated aortic bioprosthesis: Technical considerations and results

TY - JOUR

T1 - Use of transcatheter heart valves for a valve-in-valve implantation in patients with degenerated aortic bioprosthesis

T2 - Technical considerations and results

AU - Bapat, Vinayak

AU - Attia, Rizwan

AU - Redwood, Simon

AU - Hancock, Jane

AU - Wilson, Karen

AU - Young, Christopher

AU - Thomas, Martyn

PY - 2012/12

Y1 - 2012/12

N2 - Objective: Transcatheter aortic valve implantation has been used to treat high-risk patients with bioprosthetic valve degeneration (valve-in-valve). We report our experience with transcatheter aortic valve implantation in the treatment of degenerated biologic aortic valve prostheses and discuss factors that can influence the outcome. Methods: From February 2009 to October 2011, 278 patients underwent transcatheter aortic valve implantation, of whom 23 underwent a valve-in-valve procedure with the Edwards Sapien valve to treat a failing bioprostheses in the aortic position. Eight of these valves were stentless bioprostheses. Thirteen patients had valve failure resulting predominantly from stenosis, and the remaining resulting from regurgitation. Results: Mean age was 76.9 +/- 14.4 years. The mean logistic EuroSCORE was 31.8% +/- 20.3% and the Society of Thoracic Surgeons score was 7.6% +/- 5.4%. All patients were New York Heart Association class III or IV. The majority of the operations (21/23) were performed via the transapical route. Procedural success was 100%, although 1 patient with a degenerated homograft needed immediate placement of a second valve because of low placement of the first. The reduction in the mean gradient was 31.2 +/- 17.06 mm Hg to 9.13 +/- 4.9 mm Hg. In those patients with predominant aortic regurgitation (9/23), reduction in aortic regurgitation was achieved in all. The median length of stay was 11.7 days (range, 3-44 days). In-hospital and/or 30-day mortality was 0%. Conclusions: Valve-in-valve is a safe and feasible alternative to treat high-risk patients with failing aortic bioprostheses. The early results are excellent, with improvement seen in hemodynamics.

AB - Objective: Transcatheter aortic valve implantation has been used to treat high-risk patients with bioprosthetic valve degeneration (valve-in-valve). We report our experience with transcatheter aortic valve implantation in the treatment of degenerated biologic aortic valve prostheses and discuss factors that can influence the outcome. Methods: From February 2009 to October 2011, 278 patients underwent transcatheter aortic valve implantation, of whom 23 underwent a valve-in-valve procedure with the Edwards Sapien valve to treat a failing bioprostheses in the aortic position. Eight of these valves were stentless bioprostheses. Thirteen patients had valve failure resulting predominantly from stenosis, and the remaining resulting from regurgitation. Results: Mean age was 76.9 +/- 14.4 years. The mean logistic EuroSCORE was 31.8% +/- 20.3% and the Society of Thoracic Surgeons score was 7.6% +/- 5.4%. All patients were New York Heart Association class III or IV. The majority of the operations (21/23) were performed via the transapical route. Procedural success was 100%, although 1 patient with a degenerated homograft needed immediate placement of a second valve because of low placement of the first. The reduction in the mean gradient was 31.2 +/- 17.06 mm Hg to 9.13 +/- 4.9 mm Hg. In those patients with predominant aortic regurgitation (9/23), reduction in aortic regurgitation was achieved in all. The median length of stay was 11.7 days (range, 3-44 days). In-hospital and/or 30-day mortality was 0%. Conclusions: Valve-in-valve is a safe and feasible alternative to treat high-risk patients with failing aortic bioprostheses. The early results are excellent, with improvement seen in hemodynamics.

KW - CLINICAL-APPLICATION

KW - EDWARDS SAPIEN

KW - REPLACEMENT

KW - STENOSIS

KW - REGURGITATION

KW - OUTCOMES

KW - COHORT

U2 - 10.1016/j.jtcvs.2012.07.104

DO - 10.1016/j.jtcvs.2012.07.104

M3 - Article

SN - 0022-5223

VL - 144

SP - 1372

EP - 1380

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

IS - 6

ER -