Thorac Cardiovasc Surg
DOI: 10.1055/s-0041-1724038
Short Communication

Transcatheter Aortic Valve Replacement for a Degenerated Transcatheter Valve—A Single Center Experience

1  Department of Cardiovascular Surgery, German Heart Centre, Munich, Germany
2  Department of Cardiovascular Surgery, INSURE (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
,
Hendrik Ruge
1  Department of Cardiovascular Surgery, German Heart Centre, Munich, Germany
2  Department of Cardiovascular Surgery, INSURE (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
,
Ruediger Lange
1  Department of Cardiovascular Surgery, German Heart Centre, Munich, Germany
2  Department of Cardiovascular Surgery, INSURE (Institute of Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
› Author Affiliations

Abstract

Background The transcatheter valve-in-valve treatment (TAV-in-TAV) of degenerated transcatheter aortic valves is becoming more relevant, as the use of transcatheter aortic valve replacement (TAVR) increases. We report our experience with TAV-in-TAV in patients with a degenerated transcatheter heart valve (THV).

Methods We retrospectively analyzed prospectively collected data from our designated TAVR database. Intraprocedural and intrahospital outcomes were reported.

Results Ten patients out of a total of 3,144 TAVR implantations since 2007 presented with a degenerated THV, among those six with an Edwards Sapien XT (Edwards Lifesciences, Irvine, California, United States) valve, treated with a Medtronic Evolut R (Medtronic, Dublin, Ireland) valve. Four patients had severe stenosis, one pure insufficiency, and five combined stenosis and insufficiency. Average time between initial implantation and re-intervention was 6.8 ± 1.3 years. The mean preoperative maximum and mean gradients were 54.2 ± 14.8 mm Hg and 31.6 ± 9.9 mm Hg, respectively. Nine patients underwent transfemoral and one patient underwent transaortic TAV-in-TAV. Mean procedural time was 86.2 ± 51.5 minutes. Post-implantation, the maximum and mean gradients decreased to 18 ± 6.9 mm Hg and 8.4 ± 3.2 mm Hg (16 ± 8 mm Hg and 6.4 ± 1.7 mm Hg in the Evolut-in-Sapien subgroup), respectively. The valve area increased from 0.98 ± 0.28 mm Hg to 1.72 ± 0.32 mm Hg (0.8 ± 0.07 mm Hg to 1.9 ± 0.16 mm Hg in the Evolut-in-Sapien subgroup). Two patients experienced a vascular complication. No further Valve Academic Research Consortium-2 criteria complications occurred during hospitalization.

Conclusion TAV-in-TAV resulted in low procedural and peri-procedural complication rates. In particular, the usage of a supra-annular valve resulted in excellent hemodynamic results. Larger studies are required to validate this observational data and to establish a protocol for this procedure.



Publication History

Received: 25 August 2020

Accepted: 30 December 2020

Publication Date:
24 February 2021 (online)

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany