Advertisement

Clinical Research in Cardiology

, Volume 108, Issue 10, pp 1069–1073 | Cite as

Two birds with one stone: transcatheter valve-in-valve treatment of a failed surgical bioprosthesis with concomitant severe stenosis and paravalvular leak

  • Hector A. Alvarez-Covarrubias
  • Erion Xhepa
  • Jonathan M. Michel
  • A. Markus KaselEmail author
Critical Perspective
  • 225 Downloads

Abstract

Implantation of bioprosthetic surgical valves has been a common procedure in elderly patients with severe aortic stenosis due to patients´ preferences avoiding anticoagulation therapy. However, this valve presents sometime certain deterioration degree (i.e., dysfunction due to stenosis or regurgitation) or even paravalvular leak. Transcatheter heart valve implantation is a good alternative in high-risk patients. The valve-in-valve procedure has been shown to be a safe and effective procedure. However, the presence of the fixed sewing ring of the surgical bioprosthesis can hamper appropriate expansion of the THV. For this reason, the use of cracking balloon seems to be a safe alternative to increase the effective orifice area. We present a case of a patient with a degenerated previous implanted biological valve and paravalvular leak. We used the treatment strategy of valve-in-valve with post-dilatation with high-pressure balloon, in a way to treat both, the degenerated valve and the paravalvular leak. The use of a single percutaneous procedure was enough and safe to treat both problems without further complications.

Graphic abstract

Keywords

TAVI TAVR Fracturing Cracking Paravalvular leak Valve-in-valve 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

A. M. Kasel is proctor and consultant for Edwards Lifesciences. The other authors have no conflicts of interest to declare.

Supplementary material

392_2019_1519_MOESM1_ESM.mp4 (24.2 mb)
Supplementary material 1 (MP4 24804 kb)

References

  1. 1.
    Capodanno D, Petronio AS, Prendergast B, Eltchaninoff H, Vahanian A, Modine T, Lancellotti P, Sondergaard L, Ludman PF, Tamburino C, Piazza N, Hancock J, Mehilli J, Byrne RA, Baumbach A, Kappetein AP, Windecker S, Bax J, Haude M (2017) Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 38(45):3382–3390.  https://doi.org/10.1093/eurheartj/ehx303 CrossRefPubMedGoogle Scholar
  2. 2.
    Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, Gerosa G, Ibrahim R, Jelnin V, Jilaihawi H, Jolicoeur EM, Kliger C, Kronzon I, Leipsic J, Maisano F, Millan X, Nataf P, O’Gara PT, Pibarot P, Ramee SR, Rihal CS, Rodes-Cabau J, Sorajja P, Suri R, Swain JA, Turi ZG, Tuzcu EM, Weissman NJ, Zamorano JL, Serruys PW, Leon MB, Paravalvular Leak Academic Research C (2018) Clinical trial principles and endpoint definitions for paravalvular leaks in surgical prosthesis. Eur Heart J 39(15):1224–1245.  https://doi.org/10.1093/eurheartj/ehx211 CrossRefPubMedGoogle Scholar
  3. 3.
    Ionescu A, Fraser AG, Butchart EG (2003) Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography. Heart 89(11):1316–1321CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Dvir D, Webb JG, Bleiziffer S, Pasic M, Waksman R, Kodali S, Barbanti M, Latib A, Schaefer U, Rodes-Cabau J, Treede H, Piazza N, Hildick-Smith D, Himbert D, Walther T, Hengstenberg C, Nissen H, Bekeredjian R, Presbitero P, Ferrari E, Segev A, de Weger A, Windecker S, Moat NE, Napodano M, Wilbring M, Cerillo AG, Brecker S, Tchetche D, Lefevre T, De Marco F, Fiorina C, Petronio AS, Teles RC, Testa L, Laborde JC, Leon MB, Kornowski R, Valve-in-Valve International Data Registry I (2014) Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. JAMA 312(2):162–170.  https://doi.org/10.1001/jama.2014.7246 CrossRefPubMedGoogle Scholar
  5. 5.
    Wernly B, Zappe AK, Unbehaun A, Sinning JM, Jung C, Kim WK, Fichtlscherer S, Lichtenauer M, Hoppe UC, Alushi B, Beckhoff F, Wewetzer C, Franz M, Kretzschmar D, Navarese E, Landmesser U, Falk V, Lauten A (2019) Transcatheter valve-in-valve implantation (VinV-TAVR) for failed surgical aortic bioprosthetic valves. Clin Res Cardiol 108(1):83–92.  https://doi.org/10.1007/s00392-018-1326-z CrossRefPubMedGoogle Scholar
  6. 6.
    Seoudy H, Gussefeld N, Frank J, Freitag-Wolf S, Lutter G, Eden M, Rangrez AY, Kuhn C, Frey N, Frank D (2018) Incidence and impact of prosthesis-patient mismatch following transcatheter aortic valve implantation. Clin Res Cardiol.  https://doi.org/10.1007/s00392-018-1394-0 CrossRefPubMedGoogle Scholar
  7. 7.
    Chhatriwalla AK, Allen KB, Saxon JT, Cohen DJ, Aggarwal S, Hart AJ, Baron SJ, Dvir D, Borkon AM (2017) Bioprosthetic valve fracture improves the hemodynamic results of valve-in-valve transcatheter aortic valve replacement. Circ Cardiovasc Interv.  https://doi.org/10.1161/circinterventions.117.005216 CrossRefPubMedGoogle Scholar
  8. 8.
    Sathananthan J, Sellers S, Barlow AM, Stanova V, Fraser R, Toggweiler S, Allen KB, Chhatriwalla A, Murdoch DJ, Hensey M, Lau K, Alkhodair A, Dvir D, Asgar AW, Cheung A, Blanke P, Ye J, Rieu R, Pibarot P, Wood D, Leipsic J, Webb JG (2019) Valve-in-valve transcatheter aortic valve replacement and bioprosthetic valve fracture comparing different transcatheter heart valve designs: an ex vivo bench study. JACC Cardiovasc Interv 12(1):65–75.  https://doi.org/10.1016/j.jcin.2018.10.043 CrossRefPubMedGoogle Scholar
  9. 9.
    Webb JG, Dvir D (2013) Transcatheter aortic valve replacement for bioprosthetic aortic valve failure: the valve-in-valve procedure. Circulation 127(25):2542–2550.  https://doi.org/10.1161/CIRCULATIONAHA.113.000631 CrossRefPubMedGoogle Scholar
  10. 10.
    Millan X, Skaf S, Joseph L, Ruiz C, Garcia E, Smolka G, Noble S, Cruz-Gonzalez I, Arzamendi D, Serra A, Kliger C, Sia YT, Asgar A, Ibrahim R, Jolicoeur EM (2015) Transcatheter reduction of paravalvular leaks: a systematic review and meta-analysis. Can J Cardiol 31(3):260–269.  https://doi.org/10.1016/j.cjca.2014.12.012 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Hector A. Alvarez-Covarrubias
    • 1
    • 2
  • Erion Xhepa
    • 1
  • Jonathan M. Michel
    • 1
  • A. Markus Kasel
    • 1
    Email author
  1. 1.Cardiology DepartmentGerman Heart Center Munich, Technical University MunichMunichGermany
  2. 2.Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSSMexico CityMexico

Personalised recommendations