Management of implant failure during transcatheter aortic valve implantation

Abstract

Early implant failure can complicate the TAVI procedure with the CoreValve system, but it can be managed safely and effectively with bailout transcatheter techniques, avoiding surgery, with good early and mid-term clinical and echocardiographic results.

Anatomical and Procedural Features Associated With Aortic Root Rupture During Balloon-Expandable Transcatheter Aortic Valve Replacement

“…20 In our analysis, balloon postdilatation confers an odds ratio with a high statistical association with aortic rupture, but, because of the rarity of data for such an estimation, no definitive conclusion can be made on its association with the outcome. However, our data would recommend that greater caution should be taken when oversizing or performing balloon postdilatation in patients with significant LVOT calcification.…”

Paravalvular Aortic Leak After Transcatheter Aortic Valve Replacement

“…54 Outcomes data from the Italian CoreValve registry in which 24 patients underwent valve-in-valve are encouraging, showing 100% procedural success and outcomes similar to uneventfully placed valves. 55 The most common reason for redeployment was low positioning of the THV (75% of cases).…”

Transcatheter aortic valve replacement

“…If the valve embolizes into the left ventricle, surgical removal is usually necessary. 44,48,78,102 If valve misalignment results in severe aortic regurgitation, an attempt can be made to position a second transcatheter heart valve within the first one to reduce regurgitation. 78,102 Transcatheter heart valves that allow recapturing and repositioning of the valve after deployment are currently undergoing clinical evaluation.…”

“…44,48,78,102 If valve misalignment results in severe aortic regurgitation, an attempt can be made to position a second transcatheter heart valve within the first one to reduce regurgitation. 78,102 Transcatheter heart valves that allow recapturing and repositioning of the valve after deployment are currently undergoing clinical evaluation. [69][70][71] Coronary artery obstruction can result from malpositioning of the valve, but the most likely cause is the displacement of a calcified leaflet over a coronary ostium or the embolization of debris into one of the coronary arteries.…”

“…47,[118][119][120][121][122][123] Implanting a second transcatheter heart valve in a malpositioned or regurgitant transcatheter heart valve is a feasible bailout that has adequate results, but the resulting gradient is higher than in patients undergoing SAVR. 78,102,121 SAPIEN valve implantations in CoreValve as well as CoreValve implantations in failing SAPIEN valves have been described. 47 In patients with a failing surgical aortic bioprosthesis with high risk of reoperation, implanting a transcatheter heart valve within the bioprosthesis is a minimally invasive alternative to surgery.…”