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September 8, 2010Catheterization and Cardiovascular Interventions

Transcatheter aortic valve implantation for treatment of patients with degenerated aortic bioprostheses—valve‐in‐valve technique

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Why the study?

Does transfemoral TAVI improve hemodynamics and symptoms in high-risk patients with degenerated aortic bioprostheses?

Population

5 patients with degenerated aortic valve bioprostheses, excessive operative risk, symptoms of heart failure…

Design

Case_series

Follow-up

mean 72 days ± 60 (range: 30-176 days)

Key result

Transfemoral TAVI using the valve-in-valve technique was successful in all 5 high-risk patients with degenerated aortic bioprostheses, significantly decreasing transaortic pressure (P=0.002).

Authors

MGMichael GotzmannAMAndreas MüggeWBWaldemar Bojara

Discussion

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Overview

May support valve-in-valve TAVI in select high-risk cases; hypothesis-generating and requires larger prospective validation.

Key Points

  • To assess the feasibility and hemodynamic outcomes of transfemoral transcatheter aortic valve implantation using the valve-in-valve technique in patients with failing surgical aortic bioprostheses.
  • Enrolled 5 high-risk patients (EuroSCORE ≥ 30%, NYHA ≥ III) with degenerated aortic valve bioprostheses and an internal diameter of 20.5 ± 0.5 mm.
  • Performed retrograde transfemoral implantation of a 26-mm CoreValve prosthesis following balloon valvuloplasty under rapid pacing without hemodynamic support.
  • Assessed invasive hemodynamics and echocardiographic parameters pre- and post-procedure, with clinical follow-up over a mean of 72 ± 60 days (range: 30–176 days).
  • All 5 procedures achieved procedural success with an immediate decrease in transaortic peak-to-peak pressure (P = 0.002).
  • Left ventricular ejection fraction increased significantly (P = 0.019) and NYHA functional class improved in all patients.
  • Complications included mild aortic regurgitation in 2 patients and permanent pacemaker implantation in 1 patient, with zero major adverse cardiac or cerebrovascular events.

Study Design

Type

Case Report (n=5)

Structured PICO

Does transfemoral TAVI improve hemodynamics and symptoms in high-risk patients with degenerated aortic bioprostheses?

P
Population
5 high-risk patients with degenerated aortic bioprostheses and heart failure symptoms treated with transfemoral TAVI, followed for a mean of 72 days.
I
Intervention
Transfemoral transcatheter aortic valve implantation (TAVI) using a 26-mm CoreValve prosthesis (18-F-generation) inserted retrograde under fluoroscopic guidance, preceded by balloon valvuloplasty with a 20-mm balloon under rapid pacing
O
Outcome
Immediate decrease of transaortic peak-to-peak pressuresurrogate

Main Result

p-value: p=0.002

Transfemoral TAVI using the valve-in-valve technique is feasible and improves hemodynamics in high-risk patients with degenerated aortic bioprostheses.

Cite This Study

Gotzmann et al. (2010) conducted a case report in Degenerated aortic bioprostheses (n=5). Transfemoral transcatheter aortic valve implantation (TAVI) using 26-mm CoreValve prosthesis was evaluated on Immediate decrease of transaortic peak-to-peak pressure (p=0.002). Transfemoral TAVI using the valve-in-valve technique was successful in all 5 high-risk patients with degenerated aortic bioprostheses, significantly decreasing transaortic pressure (P=0.002).

synapsesocial.com/papers/6a9afdd2d7741531f663badbhttps://doi.org/10.1002/ccd.22738
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