Pablo Codner1, Abid Assali1, Hana Vaknin-Assa1, Yaron Shapira1, Katia Orvin1, Ram Sharony1, Alexander Sagie1, Ran Kornowski1
Departments of 1Cardiology and 2Cardiac and Thoracic Surgery, Beilinson and Hasharon Hospitals, Rabin Medical Center, Petah Tikva, ‘Sackler’ Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Background and aim of the study: The percutaneous approach for a failed bioprosthetic valve is an emerging alternative to redo-valve surgery in patients at high surgical risk. The study aim was to describe the treatment of patients with structural bioprosthetic valve deterioration, using the valve-in-valve technique.
Methods: A total of 33 consecutive patients with symptomatic structural bioprosthetic valve deterioration was treated at the authors’ institution, using the valve-in-valve technique.
Results: The valve-in-valve procedure in the aortic position was performed in 23 patients (mean age 81.4 ± 5.9 years; mean STS score 9.6 ± 5.4). The self-expandable and balloon-expandable devices were used in 21 cases (91.3%) and two cases (8.7%), respectively. Procedures were performed via the trans-femoral, trans-axillary and trans-apical routes in 18 (78.2%), three (13%) and two (8.7%) cases, respectively. After the procedure, all patients were in NYHA class I/II. Survival rates were 95.6% at the one year follow up. The valve-in-valve procedure in the mitral position was performed in 10 patients (mean age 73.6 ± 15 years; mean STS score 7.7 ± 4.1). All procedures were performed using the balloon-expandable device via the trans-apical route. The composite end point of device success was achieved in all patients. Survival rates were 100% and 75% at one month and two
years’ follow up, respectively. A single valve-in-valve implantation within a failed tricuspid bioprosthetic valve was also successfully performed.
Conclusion: In the authors’ experience, the valve-in-valve technique for the treatment of a wide range of bioprosthetic valve deterioration modes of failure in different valve positions is safe and very effective.
Video 1: Combined aortic and mitral trans-apical valve-in-valve procedure. First the Edwards-Sapien XT 26mm device was deployed within a failed Carpentier-Edwards Porcine 25mm bioprosthetic valve in the aortic position.
Video 2: Combined aortic and mitral trans-apical valve-in-valve procedure. Following implantation of an aortic balloon expandable valve in the aortic position, the Edwards-Sapien XT 29mm device was deployed within a failed Carpentier-Edwards Porcine 27mm bioprosthetic valve in the mitral position.
Video 3: Transcatheter valve in valve implantation in the tricuspid location using a 29mm balloon expandable Sapien XT valve via the femoral vein, for the treatment of severe bioprosthetic valve deterioration in the form of tricuspid stenosis.
The Journal of Heart Valve Disease 2015;24:345-352
|Treatment of Aortic, Mitral and Tricuspid Structural Bioprosthetic Valve Deterioration Using the Valve-in-Valve Technique|
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