Transcatheter Aortic Valve Implantation in Degenerate Failing Aortic Homograft Root Replacements

Q: What is the clinical evidence from this study?

Study design: Letter. Population: Severe aortic regurgitation due to structural degeneration of a prior aortic homograft root replacement (n=5). Intervention: Transcatheter Aortic Valve Implantation (TAVI) with Medtronic CoreValve. Primary outcome: Procedural success.

Pak Hei Chan; Carlo Di Mario; Simon Davies; Andrea Kelleher; Richard Trimlett; Neil Moat

doi:10.1016/j.jacc.2011.07.018

October 1, 2011Journal of the American College of CardiologyOpen Access

Transcatheter Aortic Valve Implantation in Degenerate Failing Aortic Homograft Root Replacements

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Key result

Self-expanding TAVI yields 100% procedural success for degenerated prior aortic homograft root replacements.

n=5

Why the study?

Does transcatheter aortic valve implantation (TAVI) improve procedural success and hemodynamics in patients with structural degeneration of a prior aortic homograft root replacement?

Key Points

To evaluate the feasibility and outcomes of transcatheter aortic valve implantation using a self-expanding prosthesis in patients with structural degeneration of a prior aortic homograft root replacement.
Treated 5 consecutive high-risk patients with degenerate aortic homografts using the size-26 Medtronic CoreValve under general anesthesia and transesophageal echocardiography guidance.
Initial device success was 80%, with 1 patient requiring a second valve during the same procedure due to deep ventricular positioning, resulting in 100% final procedural success and no more than mild aortic regurgitation at follow-up.
Mean aortic gradient decreased from 24.0 ± 16.5 mm Hg before intervention to 8.2 ± 2.8 mm Hg post-procedurally (p = 0.07).
Observed no access site complications, strokes, or requirements for permanent pacemakers according to Valve Academic Research Consortium definitions.

Structured PICO

Does transcatheter aortic valve implantation (TAVI) improve procedural success and hemodynamics in patients with structural degeneration of a prior aortic homograft root replacement?

P

Population

5 patients (mean age 73.4 years, 40% female) with severe aortic regurgitation due to structural degeneration of a prior aortic homograft root replacement who underwent TAVI, followed for up to 713 days.

I

Intervention

Transcatheter aortic valve implantation (TAVI) with a size-26 self-expanding prosthesis (Medtronic CoreValve)

O

Outcome

Device success (defined as successful deployment of CoreValve prosthesis in optimal aortic position with ≤2 paraprosthetic aortic regurgitation and successful retrieval of delivery system)

TAVI with a self-expanding prosthesis is feasible and results in symptomatic improvement and reduced aortic gradients in patients with severe aortic regurgitation due to structural degeneration of a prior aortic homograft root replacement.

Limitations

Small size of the study
small size of the study

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Implication

Supports TAVI feasibility in degenerated homografts; leaves open durability and comparative effectiveness in larger cohorts.

Abstract

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Cite This Study

Chan et al. (2011) conducted a letter in Severe aortic regurgitation due to structural degeneration of a prior aortic homograft root replacement (n=5). Transcatheter Aortic Valve Implantation (TAVI) with Medtronic CoreValve was evaluated on Procedural success.

synapsesocial.com/papers/6a62d9a4d8aa0f02ee9ceec7 https://doi.org/10.1016/j.jacc.2011.07.018

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Transcatheter Aortic Valve Implantation in Degenerate Failing Aortic Homograft Root Replacements

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Transcatheter Aortic Valve Implantation in Degenerate Failing Aortic Homograft Root Replacements

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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