Post-implantation transcatheter aortic valve migration in a left ventricular assist device patient with severe aortic insufficiency

Transfemoral transcatheter aortic valve replacement with a self-expanding valve for severe aortic regurgitation in a patient with left ventricular assist device

“…Appropriate oversizing is of utmost importance to maximize anchoring of the valve at the annulus, to reduce the possibility of ventricular migration, and to optimize hemodynamics in the setting of a LVAD. Of the previous seven cases of TAVR in patients with LVAD and aortic valve insufficiency in non‐calcified or minimally calcified aortic valve described in the literature, only one was performed with a balloon‐expandable valve as the sole valve . Of the six cases performed with a Medtronic Corevalve, one required further post‐dilation for residual aortic regurgitation and two experienced ventricular migration of the transcatheter valve, one of which was treated with the implantation of a second Corevalve .…”

“…In a similar previously reported case of successful implantation without the need for additional valve implantation or balloon post‐dilation, the oversizing of our valve perimeter was ≥20%. Of the two cases with reported ventricular migration, oversizing by perimeter was less than 15%, perhaps suggesting that a greater degree of oversizing by perimeter may be required to maximize TAVR success with self‐expandable valves in non‐calcified aortic valve with pure AI. It is also possible that the more aortic initial position, and the stabilization of the LVAD outflow cannula, may have contributed to the success in this patient.…”

Emergency transcatheter aortic valve implantation in patients with severe aortic regurgitation and a left ventricle assist device: A case report and systematic review

“…Valve migration might be a serious risk in this population, even hours after the initial procedure, an example being the case in Ong. 4…”

“…Including our case as described above, nine cases have been published reporting TAVI treatment for severe aortic regurgitation in LVAD patients. [1][2][3][4][5][7][8][9] One TAVI was performed in a patient with aortic valve stenosis due to fusion of the leaflets in a failing LVAD. 6,10 In nine of the 10 cases the implanted LVAD was a Heartmate-2 and in one case a Heartware (Heartware, Framingham, MA, USA).…”

“…Valve migration might be a serious risk in this population, even hours after the initial procedure, an example being the case in Ong. 4 In LVAD patients presenting with cardiogenic shock due to severe aortic regurgitation there is a continuous reverse flow and negative pressure gradient over the aortic valve. When the rotations of the LVAD are increased this will result in even more recirculating volume and more suction of the LVAD inlet.…”