Why the study?
Non-functional mechanical valves typically require surgical redo, and breaking carbon leaflets before transcatheter valve-in-valve implantation into the remaining ring had never been described.
Can a transcatheter valve be successfully implanted into a non-functional mechanical bileaflet aortic prosthesis after fracturing the carbon discs?
Can a transcatheter valve be successfully implanted into a non-functional mechanical bileaflet aortic prosthesis after fracturing the carbon discs?
This case demonstrates the first successful transcatheter valve-in-valve implantation into a failed mechanical prosthetic aortic valve facilitated by fracturing the carbon leaflets.
Feasibility of valve-in-valve TAVR after mechanical leaflet fracture shown in one case; leaves open need for validation in larger cohorts.
Background Degenerated and failed bioprosthetic cardiac valves can safely be treated with transcatheter valve-in-valve implantation in patients at high risk for reoperation. So far, non-functional mechanical valves must be treated with a surgical redo. Breaking the carbon leaflets before implanting a transcatheter valve into the remaining ring has never been described before. Case summary Here, we present the case of a 65-year-old male patient with severe heart failure, poor left ventricular function based on a fully immobile disc of his mechanical bileaflet aortic valve implanted 7 years ago. After the heart team declined to reoperate the patient due to his extremely high risk, we considered a transcatheter valve-in-valve implantation as the ultimate treatment approach. After successful interventional cracking of the leaflets in vitro, this approach, together with implanting a balloon-expandable transcatheter aortic valve replacement (TAVR) into the remaining ring, was performed under cerebral protection. The intervention resulted in a fully functional TAVR, improvement of heart function, and early discharge from the hospital. Discussion This case demonstrates the possibility to implant a transcatheter valve successfully into a non-functional mechanical bileaflet aortic prosthesis after fracturing the carbon discs while the brain is protected by a filter system. Critical steps of the procedure were identified. This new therapeutic approach might be offered to a limited patient cohort who is not eligible for a surgical redo.
No takes yet. Share an insight, caveat, or question.
Butter et al. (2021) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: