Volume 92, Issue 3 pp. 550-554
Valvular and Structural Heart Diseases

Optimizing hemodynamics of transcatheter aortic valve-in-valve implantation in 19-mm surgical aortic prostheses

Jayendrakumar S. Patel MD

Jayendrakumar S. Patel MD

Heart & Vascular Institute, Cleveland Clinic

Search for more papers by this author
Amar Krishnaswamy MD

Amar Krishnaswamy MD

Heart & Vascular Institute, Cleveland Clinic

Search for more papers by this author
Jonathon White MD

Jonathon White MD

Heart & Vascular Institute, Cleveland Clinic

Search for more papers by this author
Stephanie Mick MD

Stephanie Mick MD

Heart & Vascular Institute, Cleveland Clinic

Search for more papers by this author
Jose Navia MD

Jose Navia MD

Heart & Vascular Institute, Cleveland Clinic

Search for more papers by this author
Anand Mehta MD

Anand Mehta MD

Heart & Vascular Institute, Cleveland Clinic

Search for more papers by this author
Faisal Bakaeen MD

Faisal Bakaeen MD

Heart & Vascular Institute, Cleveland Clinic

Search for more papers by this author
Zoran Popovic MD PhD

Zoran Popovic MD PhD

Heart & Vascular Institute, Cleveland Clinic

Search for more papers by this author
Lars Svensson MD, PhD

Lars Svensson MD, PhD

Heart & Vascular Institute, Cleveland Clinic

Search for more papers by this author
Samir R. Kapadia MD

Corresponding Author

Samir R. Kapadia MD

Heart & Vascular Institute, Cleveland Clinic

Correspondence Samir R. Kapadia, MD, Sones Catheterization Laboratories, 9500 Euclid Avenue, Mail Code J2-3, Cleveland, OH 44195. Email: [email protected]Search for more papers by this author
First published: 11 December 2017
Citations: 8

Abstract

Objective

To demonstrate the feasibility of achieving good hemodynamic results with valve-in-valve transcatheter aortic valve replacement (ViV TAVR) for degenerated 19 mm surgical bioprosthetic valves.

Background

Considerable controversy exists regarding ViV TAVR within 19mm surgical prostheses due to concerns of elevated valve gradients and mortality.

Methods

Among all patient undergoing ViV TAVR between 7/2016 and 4/2017 for symptomatic severe bioprosthetic aortic stenosis (AS), five had a 19 mm surgical valve in place and were included in this publication. None of the patients had patient-prosthesis mismatch. Aggressive post-dilation was performed in four out of five cases using a special technique we describe below.

Results

In all cases, mean aortic valve (AV) gradients significantly improved post-ViV TAVR, particularly after post-dilation. Interestingly, high pressure post-dilation of the ViV resulted in an increase in the diameter of surgical valve stent frame dimensions in nearly all patients who underwent post-dilation.

Conclusions

Good hemodynamic outcome is possible with aggressive post-dilation in patients with 19 mm failed surgical bioprostheses. High-risk patients with 19 mm failed surgical prostheses who do not otherwise have viable surgical options should be considered for ViV TAVR.

CONFLICT OF INTEREST

Nothing to report.

The full text of this article hosted at iucr.org is unavailable due to technical difficulties.