When operable patients become inoperable: Conversion of a surgical aortic valve replacement into transcatheter aortic valve implantation

Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Interactive Cardiovascular and Thoracic Surgery (Impact Factor: 1.16). 09/2009; 9(5):837-9. DOI: 10.1510/icvts.2009.211144
Source: PubMed


Transcatheter aortic valve implantation (TAVI) is a relatively new treatment option for inoperable patients with severe aortic stenosis (AS). This case describes how a planned conventional surgical aortic valve replacement (AVR) on a 73-year-old woman was successfully converted to a TAVI procedure. On extracorporal circulation it was reconized that the aortic annulus, the coronary ostiae and the proximal part of the ascending aorta were severely calcified making valve implantation impossible. Surgical closure without valve substitution was estimated to be associated with a high risk of mortality due to the imparied left ventricular function. Consequently, TAVI was performed with a CoreValve ReValving System prosthesis. The delivery of the valve prosthesis was made through the ascending part of aorta, proximal of the cannulation of aorta. Positioning of the valve prosthesis was made under visual guidance, and the prosthesis was sutured to the ascending aorta. With some manipulation of the prosthesis it was possible to suture the aorta circumferentially around the fully expanded upper part of the prosthesis. Post-procedurally the patient recovered successfully, with improved function capacity, aortic valve area and left ventricle function.

Download full-text


Available from: Lars Sondergaard, Sep 26, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper deals with the significance of the envelope detection operation, commonly performed on the output signals generated by a sonar imaging system, before of the visualisation. Although imaging systems are often linear processes, envelope detection destroys phase information, thus producing a nonlinear contribution. Within this paper, the relative importance of the nonlinear contribution is evaluated, in a general way, and its incidence in real sonar systems has been analysed, in a practical way, by performing several simulations. Simulations results have pointed out a considerable incidence of such nonlinearities on the quality of obtained images
    No preview · Conference Paper · Jul 1996

  • No preview · Article · Nov 2009 · Interactive Cardiovascular and Thoracic Surgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Surgical aortic valve replacement (SAVR) is the only treatment known to improve symptoms and survival in patients with severe, symptomatic aortic stenosis. Perioperative mortality, however, is high among many patients for whom SAVR may be indicated. Percutaneous heart valve replacement (PHVR) is an emerging, catheter-based technology that allows for implantation of a prosthetic valve without open heart surgery. This review describes the available literature on PHVR for aortic stenosis, which comprised 84 published reports representing 76 distinct studies and 2375 unique patients. Successful implantation was achieved in 94% of patients; 30-day survival was 89%. Differences between patients undergoing PHVR and those typically selected for SAVR make full interpretation of these results difficult. A large, multicenter, randomized, controlled trial comparing PHVR with SAVR or medical management was recently completed, with initial results expected in September 2010. Pending publication of findings from that trial, the available evidence is inadequate to determine the most appropriate clinical role of PHVR or the specific patient populations for whom it might eventually be indicated.
    Full-text · Article · Sep 2010 · Annals of internal medicine
Show more