Transcatheter Aortic Valve Implantation for Stenosed and Regurgitant Aortic Valve Bioprostheses CoreValve for Failed Bioprosthetic Aortic Valve Replacements

Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
Journal of the American College of Cardiology (Impact Factor: 16.5). 01/2010; 55(2):97-101. DOI: 10.1016/j.jacc.2009.06.060
Source: PubMed


Transcatheter aortic valve implantation is increasingly being used to treat severe aortic stenosis in patients with high operative risk. In an aging population the incidence of aortic stenosis is rising, and increasing numbers of elderly patients are undergoing aortic valve replacement with bioprosthetic valves. Therefore, there is a corresponding increase in prosthetic degeneration. This presents cardiologists with a cohort of patients for whom the risk of re-do aortic valve surgery is prohibitive. We present the first series of such patients with degenerative bioprosthetic stenosis or regurgitation successfully treated with CoreValve (Medtronic, Luxembourg) implantation.


Available from: David Hildick-Smith
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    • "Mortality rates for re-operation are high, but theoretically may be lower with valve in valve implantation using the transcatheter technique. Early reports of such procedures have been promising.[44] "
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    ABSTRACT: Aortic valve stenosis (AS) is common in the elderly. Although surgical replacement of the valve has been the gold standard of management, many patients have been excluded from surgery because they were very old, frail, or had co-morbidities that increased operative risks. In the last decade, transcatheter aortic valve implantation (TAVI) has emerged as a new treatment option suitable for these patients. This article reviews the available literature on the role of TAVI in elderly patients with severe aortic stenosis. Published studies showed that elderly individuals who underwent TAVI experienced better in-hospital recovery, and similar short and mid-term mortality compared to those underwent surgical treatment of AS. However, long-term outcomes of TAVI in elderly patients are still unknown. The available data in the literature on the effect of advanced age on clinical outcomes of TAVI are limited, but the data that are available suggest that TAVI is a beneficial and tolerable procedure in very old patients. Some of the expected complications after TAVI are reported more in the oldest patients such as vascular injures. Other complications were comparable in TAVI patients regardless of their age group. However, very old patients may need closer monitoring to avoid further morbidities and mortality.
    Journal of Geriatric Cardiology 06/2014; 11(2):163-70. DOI:10.3969/j.issn.1671-5411.2014.02.004 · 1.40 Impact Factor
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    • "However, TAVI has a series of advantages, such as minimally invasion, less physical damage and rapid postoperative recovery. Therefore, TAVI has good development and applied prospects especially in high-risk patients who have contraindications for surgical aortic valve replacement and it is increasingly being used to treat severe aortic stenosis in patients with high operative risk [13,14]. Despite the fact that TAVI has entered the mainstream as a viable treatment option for patients with symptomatic, severe aortic stenosis who are at prohibitively high surgical risk, there are still many problems associated with stent implantation including accurate and stable valve positioning, disorder of mitral valve function, risk of coronary artery obstruction and paravalvular leak [15-17]. "
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    ABSTRACT: To evaluated the feasibility and safety of new aortic valved stents in transcatheter aortic valve implantation (TAVI) using retrograde approach by in vitro testing and animal implantation.Materials and Methods: The fluid passing test, expanding and releasing tests, static and releasing tests in tube were performed for new valved stents. Transvalvular pressure gradient, effective orifice area, pre-implantation and post-implantation regurgitant volume for the new stents were detected. Then, the new stents were implanted in six pigs using retrograde approach. These pigs were euthanized 12 h after the implantation for anatomic evaluation. In vitro tests showed that the closure of the new stents leaflets were effective, and stents could be released through catheter, then expanded completely and fixed fast in the tube. The coronary artery flow rates did not changed significantly after implantation (P > 0.05), while aortic regurgitant volumes were obviously reduced (P < 0.05). No significant difference in the transvalvular pressure gradient and effective orifice area of the new stents implanted within or above the valve leaflets was found (P > 0.05). In vivo experiments indicated that TAVI was successfully performed in six pigs using retrograde approach. However, one pig was died 10 h after the implantation since the stent was not expanded completely. The leaflets in stents were opening well and no valvular regurgitation was observed in the other five pigs. And thrombosis was not found.Discussion and Conclusion: The new type of aortic valved stent designed in this study was characterized with good stability and could avoid the impact caused by valve leaflets on the coronary artery.
    Journal of Cardiothoracic Surgery 11/2013; 8(1):210. DOI:10.1186/1749-8090-8-210 · 1.03 Impact Factor
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    • "The Edwards SAPIEN valve may be better suited to VIV implantation (Kempfert et al., 2010), although the Medtronic CoreValve system has been successfully used (Khawaja et al., 2010). There are promising early results for VIV, although reports tend to be anecdotal or restricted to small case series, and no large comparative studies are currently available (Ferrari et al., 2010; Kempfert et al., 2010; Khawaja et al., 2010; Olsen et al., 2010; Sharp et al., 2010). Transvalvular gradients post-procedure are usually satisfactory (Ferrari et al., 2010; Kempfert et al., 2010; Walther et al., 2008a), while residual aortic regurgitation tends to be minimal (Kempfert et al., 2010). "

    Aortic Valve, 12/2011; , ISBN: 978-953-307-561-7
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