Assessing Potential Risks of Future Redo Transcatheter Aortic Valve Replacement in Asian Patients

Miyawaki, Norihisa; Ishizu, Kenichi; Shirai, Shinichi; Nakano, Kenji; Fukushima, Tadatomo; Ko, Euihong; Tsuru, Yasuo; Tashiro, Hiroaki; Nakamura, Miho; Tabata, Hiroyuki; Morofuji, Toru; Morinaga, Takashi; Hayashi, Masaomi; Isotani, Akihiro; Ohno, Nobuhisa; Kakumoto, Shinichi; Ando, Kenji

doi:10.1016/j.jacasi.2023.09.004

Cited by 2 publications

(1 citation statement)

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“…However, the feasible condition for redoing TAVI for Asian people is anatomically limited, and not a few patients have the potential risk of sinus sequestration by implanting a second TAV. 2) The patient, in this case, was a relatively young patient on dialysis whose prognosis may exceed the TAV durability; thus, the size and position of the first TAV were determined to assume the possibility of the future redo TAVI, and we actually implanted an out-of-range smaller balloon-expandable TAV with over-expansion. The downsides of this strategy potentially include TAV embolization, significant PVL, prosthesis-patient mismatch, and early SVD; however, out-of-range small SAPIEN 3 Ultra RESILIA TAV with an improved outer skirt and leaflets sewing mechanism resulted in satisfactory TAV hemodynamics without PVL in our case.…”

Section: Discussionmentioning

confidence: 99%

How Far Out-of-Range Smaller SAPIEN 3 Ultra RESILIA Valve Implantation with Overfilling Is Acceptable?

Miyahara,

Ishizu,

Shirai

et al. 2024

Journal of Transcatheter Valve Therapies

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With expanding indications for transcatheter aortic valve implantation (TAVI), structural valve degeneration (SVD) of transcatheter aortic valve (TAV) can occur over time.It may eventually require repeat invasive treatment in the future. Redo TAVI is considered a feasible option in such cases; however, the risk of coronary obstruction owing to sinus sequestration caused by the tilted-up first TAV leaflets is a major concern. 1) Therefore, the feasibility of redoing TAVI should be considered during initial TAVI for young patients or patients with a risk for early SVD. Case PresentationA 74-year-old female patient, who was relatively small with a body surface area of 1.32 m 2 , was referred to our Objective: The repeatability of transcatheter aortic valve implantation (TAVI) is an important issue for younger patients or patients with early structural valve deterioration (SVD) concerns. Case Presentation: A 74-year-old female patient on hemodialysis (HD) visited our hospital for symptomatic severe aortic stenosis and difficulty of HD. She was at a high risk for open-heart surgery, and our heart team decided to perform TAVI. Pre-procedural electrocardiogram showed a complete right bundle branch block, and multidetector computed tomography (MDCT) revealed a low height of coronary artery and sinotubular junction and short membrane septum. Because she was on dialysis, we were concerned about early SVD, and implanting a 23-mm SAPIEN 3 Ultra RESILIA, which was suitable for her aortic annulus, would be a high risk for sinus sequestration in the future redo TAVI. Furthermore, she was at high risk for complete atrioventricular block, and implanting a transcatheter aortic valve (TAV) at a low position was not acceptable. So, we decided to select a 20-mm SAPIEN 3 Ultra RESILIA implanting overfilling with 2 ml. TAVI was performed with no complication, and post-procedural echocardiography revealed the TAV function was acceptable, and MDCT after TAVI showed suitable anatomy for redo TAVI. Conclusion:We experienced a successful TAVI case with an out-of-range smaller SAPIEN 3 Ultra RESIRIA. An out-ofrange smaller balloon-expandable valve might be a good choice if TAVI is required to be redone in the future.

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Section: Discussionmentioning

confidence: 99%