The valve-in-valve technique: Transcatheter treatment of aortic bioprothesis malposition

Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy.
Catheterization and Cardiovascular Interventions (Impact Factor: 2.11). 04/2009; 73(5):713-6. DOI: 10.1002/ccd.21896
Source: PubMed


Percutaneous aortic valve replacement is an emerging alternative to palliative medical therapy for nonsurgical patients with severe aortic valve stenosis. The impossibility of repositioning of the current transcatheter prosthesis in case of suboptimal placement is the main limit of these devices. Here, we report on a case of an 84-year-old woman successfully treated with implantation of two 18-Fr CoreValve prosthesis (CoreValve, Irvine, California), because of the suboptimal deployment of the first one, analyzing the procedural technique and the immediate and short-term clinical and hemodynamic results.

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    ABSTRACT: Transcatheter aortic valve implantation is an alternative to conventional aortic valve replacement for patients at high surgical risk, with favorable procedural outcomes. Aortic regurgitation remains an off-label indication. Recent case reports describe the successful use of a second CoreValve inside a malpositioned first CoreValve. In the current case, we report for the first time a valve-in-valve procedure for the treatment of a severely insufficient CoreValve prosthesis using the Edwards-Sapien prosthesis.
    Catheterization and Cardiovascular Interventions 01/2009; 75(1):51-5. DOI:10.1002/ccd.22199 · 2.11 Impact Factor
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    ABSTRACT: To assess the NYHA class and the quality of life (QoL) scores after percutaneous aortic valve implantation (PAVI) with the 18-Fr CoreValve prosthesis. From April 2007 until August 2008, 57 consecutive patients with aortic stenosis were evaluated for PAVI. Of these, 30 patients with successfully prosthesis implantation had more than 5-month follow-up. QoL assessment was realized with the SF-12v2 Health-Survey, a simple questionnaire designed for self-administration that provides easily interpretable scales for physical [physical component summary (PCS)] and mental [mental component summary (MCS)] health. The questionnaire was administered before and 5 months after PAVI. All 30 patients had a marked upgrading in haemodynamic and echocardiographic parameters (peak-to-peak gradient from 64 +/- 23 to 2 +/- 0.4; P < 0.001; aortic valve area index from 0.3 +/- 0.1 to 0.9 +/- 0.3; P < 0.001), with an improvement in New York Heart Association (NYHA) class at discharge and after 5 months. Mean pre-operative SF-12v2 scores showed a severe impairment of perceived quality of life compared with general Italian population >75 years, both for physical (PCS-baseline 28.5 vs. 37.9, P < 0.001) and mental scores (MCS-baseline 37.8 vs. 45.4, P < 0.001). After 5 months, a striking improvement in both scores (PCS 41.3-MCS 48.3; P < 0.001) was observed. Our preliminary results show a marked short-term improvement in functional status and physical and mental health in patients underwent PAVI.
    European Heart Journal 06/2009; 30(14):1790-6. DOI:10.1093/eurheartj/ehp171 · 15.20 Impact Factor
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    ABSTRACT: Transcatheter aortic valve implantation (TAVI) is commonly associated with some degree of aortic regurgitation (AR) secondary to the presence of paravalvular leaks. We present the case of an 86-year-old woman diagnosed with severe aortic stenosis who underwent TAVI with a 23-mm Edwards-SAPIEN valve. The procedure complicated with a severe paravalvular leak following TAVI that was unresponsive to balloon postdilation. This complication was successfully managed with the implantation of a second valve of the same diameter within the first one ("valve-in-valve") resulting in trivial residual AR and the absence of significant transvalvular gradient at the end of the procedure.
    Catheterization and Cardiovascular Interventions 07/2009; 74(7):1116-9. DOI:10.1002/ccd.22168 · 2.11 Impact Factor
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