Delayed dislocation of a transapically implanted aortic bioprosthesis

Abstract

Trans-apical aortic bioprosthesis implantation is currently evaluated as an alternative technique in high-risk patients. We report the case of a delayed upward displacement of a prosthesis after this procedure. It is hypothesised that the asymmetric calcification of the native valve and the presence of a mitral prosthesis caused the dislocation.

One-Year Outcomes of Cohort 1 in the Edwards SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) Registry

“…The patient with apparent movement of the prosthesis after implantation had a previous mitral valve replacement in situ. 6 This patient had mild AR documented post procedure but returned 3 weeks later with severe paravalvular AR and moderate valvular AR. The patient was converted to open surgical aortic valve replacement and unfortunately died on day 7 after a stroke.…”

“…6 In addition, 2 patients were reported as having increased central AR at 1 year as confirmed by echocardiogram.…”

Standardized Endpoint Definitions for Transcatheter Aortic Valve Implantation Clinical Trials

“…Examples of such events include the following: 1) the unplanned use of cardio-pulmonary bypass to manage hemodynamic compromise or to reverse procedural complications; 2) conversion from a 'failed' percutaneous transcatheter procedure to an 'open' surgical AVR or to a surgical-access TAVI (149,150); 3) ventricular perforation (for any reason) with and without cardiac tamponade (151); 4) prosthetic valve migration or dislocation from the native aortic valve landing zone (152,153); 5) frequency, reasons, and results of post-TAVI balloon dilation; 6) frequency, reasons, and results after placement of a second valve over the original valve, so-called TAVI 'valve-in-valve' (154,155); 7) integrity of the support structure, including strut fractures, compression or other evidence of geometry distortion (requires careful serial imaging modalities including cine-fluoroscopic analyses and echocardiography) (90,156 -158); 8) instances of device recapture (with or without repositioning), or retrieval (removal from the body) which occur during the index procedure; 9) and reintervention (either percutaneous or surgical) for any reason after the index procedure (159). As appropriate, the timing of these events (during the index procedure, in-hospital, or post-discharge) should be carefully recorded.…”

Numerical analysis of the radial force produced by the Medtronic-CoreValve and Edwards-SAPIEN after transcatheter aortic valve implantation (TAVI)

“…Valve migration and atrio-ventricular block are identified as significant complications of TAVI devices [15,16]. Valve migration most frequently occurs during implantation [17,18], even though cases of delayed postimplantation migration are also reported and represent a greater risk for the patients' health [19][20][21]. Incidence of atrio-ventricular block requiring permanent pacemaker implantation after TAVI is generally higher compared to open heart-surgery [22].…”