Transcatheter aortic valve‐in‐valve implantation for failed surgical bioprosthetic valves. A minimalist approach without contrast aortography or echocardiographic guidance

Abstract

ObjectivesTo demonstrate safety, feasibility and short‐term clinical outcomes after transcatheter aortic valve‐in‐valve (ViV) implantation under local anesthesia without contrast aortography or echocardiographic guidance.BackgroundTranscatheter ViV implantation is an emerging treatment modality for patients with degenerative surgical bioprostheses. Given the radiopaque properties of the surgical aortic valve (SAV) frame, ViV procedures can often be performed with fluoroscopic guidance alone.MethodsViV implantation was performed in 37 patients with SAV failure under local anesthesia without contrast aortography. Clinical and echocardiographic data were obtained at baseline, discharge, and 30 days.ResultsMean age was 74 ± 10 years and STS predicted risk of mortality was 5.6 ± 2.4%. Mean transaortic gradient decreased from 39.4 ± 15.5 mmHg to 13 ± 6.3 mmHg at discharge (p < .001), and 20 ± 7.5 mmHg at 30 days (p < .001 compared to baseline), aortic valve area increased from 0.9 ± 0.3 cm2 to 1.2 ± 0.4 cm2 at 30 days (p = .007). No patient had more than mild aortic regurgitation. Hospital discharge occurred at a median of 2.6 ± 4.4 days. At 30‐day follow‐up there were no deaths, myocardial infarctions, strokes, repeat hospital admissions for heart failure, or renal failure. One patient (2.7%) required a new pacemaker. 93% of the patients were in New York Heart Association functional class I or II.ConclusionsTranscatheter aortic ViV implantation for selected patients with degenerative surgical bioprostheses under local anesthesia without aortography or echocardiographic guidance is feasible and safe.

A case of stuck mechanical Tricuspid Valve

“…It is a charming choice to avoid redo open heart surgery. 17 Meta-analysis reported no difference between the tricuspid mechanical and biological prosthesis. Long term survival of the mechanical valve patients has been shown in nationwide population based study.…”

The bicuspid aortic valve: Still a toothy problem

“…Compared to patients with tricuspid aortic stenosis undergoing TAVR, there appears to be similar survival despite a higher rate of post‐TAVR pacemaker implantation and stroke in patients with BAVs 1 . In this issue of Catheterization and Cardiovascular Interventions , Attinger‐Toller et al 5 present a multicenter analysis of the mid‐term clinical and echocardiographic outcomes of patients undergoing contemporary TAVR (95% transfemoral and 65% under conscious sedation) for bicuspid aortic stenosis with a current generation balloon expandable valve. The investigators analyzed 79 patients undergoing TAVR for severe bicuspid aortic stenosis at six centers, with a mean age of 76 ± 9 years and median STS‐PROM score of 3.8% (2.3, 5.5%).…”