Dataset Information

Modified valve-in-valve bailout technique of transcatheter aortic valve replacement in severe aortic regurgitation for valve jumping up to ascending aorta: a case report.

ABSTRACT:

Background

Aortic regurgitation remains a challenge for transcatheter aortic valve replacement (TAVR), because of the high risk of post-procedural migration or paravalvular leakage resulting from the anatomical and pathophysiological features.

Case summary

A 75-year-old male with symptomatic severe aortic regurgitation underwent transfemoral TAVR due to poor physical condition and a Society of Thoracic Surgeons score of 11.3%. However, complete dislodgement of the valve into the ascending aorta occurred during the operation. We performed a modified valve-in-valve technique by using an ablation catheter (instead of performing urgent surgery), and no post-interventional complications were found during hospitalization. The patient was discharged in a stable condition on postoperative Day 12. At the 6-month follow-up, echocardiography showed trivial paravalvular leakage. The left ventricular ejection fraction further improved from 30 to 48%.

Discussion

The management of valve migration can be troublesome. In this case, we performed a modified valve-in-valve technique by using an ablation catheter without post-interventional complications. This is a novel strategy for the management of emergencies, which could avoid surgical thoracotomy. Our strategy may be an alternative option in some cases of valve jumping up to the ascending aorta.

SUBMITTER: Hu Z

PROVIDER: S-EPMC9382568 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Publications

Modified valve-in-valve bailout technique of transcatheter aortic valve replacement in severe aortic regurgitation for valve jumping up to ascending aorta: a case report.

Hu Zheng Z Huang Bing B Jiang Hong H Chen Jing J

European heart journal. Case reports 20220805 8

<h4>Background</h4>Aortic regurgitation remains a challenge for transcatheter aortic valve replacement (TAVR), because of the high risk of post-procedural migration or paravalvular leakage resulting from the anatomical and pathophysiological features.<h4>Case summary</h4>A 75-year-old male with symptomatic severe aortic regurgitation underwent transfemoral TAVR due to poor physical condition and a Society of Thoracic Surgeons score of 11.3%. However, complete dislodgement of the valve into the a ...[more]

PMID: 35990599

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Project description:BackgroundLimited studies have focused on the performance of self-expandable valves (SEVs) and balloon-expandable valves (BEVs) in patients with dilatated ascending aorta (AA) undergoing transcatheter aortic valve replacement (TAVR). The present study compared the performance of widely used Edwards BEVs and domestic SEVs in patients with dilatated AA among Chinese population.MethodsWe identified and reviewed 207 patients who had baseline AA diameter ≥40 mm and underwent transfemoral TAVR. Patients were divided into two groups: SEV and BEV. The SEVs were locally manufactured valves that have received Chinese regulatory approval (Venus-A, Taurus One, and VitaFlow), while the BEVs were Edwards Sapien XT and Sapien3. Procedural device success and post-procedural changes of AA diameters were compared.ResultsThe sample size of SEV group was larger than that of BEV group because BEVs were not available in China in the early clinical practice. The overall device success was slightly lower in SEV group compared with BEV group (84.2% vs. 95.8%, P=0.213). However, in the univariable and multivariable logistic regression analyses, only bicuspid aortic valve (BAV) was found to be an independent risk factor for device failure (OR: 2.632, CI: 1.107-6.257, P=0.029). During the median follow-up of 21 months, no statistical difference was found between the two groups regarding the overall survival (83.1%±4.7% vs. 95.8%±4.1%, P=0.533), and no aortic dissection nor rupture was observed. In a subgroup of patients who had follow-up CTs ≥12-month intervals, the AA diameter appeared to remain stable in SEV group with an aortic expansion rate of 0 (-0.4 to 0.8) mm (P=0.102), while it slightly enlarged in BEV group with an aortic expansion rate of 0.4 (-0.4 to 0.6) mm/y (P=0.038). In addition, the AA diameter also slightly enlarged in patients with BAV [0.2 (0 to 1.0) mm/y, P=0.015], while it remained stable in patients with tricuspid aortic valve (TAV) [0 (-0.8 to 0.6) mm/y, P=0.640].ConclusionsIn patients with dilatated AA who underwent TAVR, the type of THVs did not affect the procedural device success. BAV appeared to be a risk factor for both device failure and higher aortic expansion rate in these patients.

Dataset Information

Modified valve-in-valve bailout technique of transcatheter aortic valve replacement in severe aortic regurgitation for valve jumping up to ascending aorta: a case report.

Background

Case summary

Discussion

Publications

Modified valve-in-valve bailout technique of transcatheter aortic valve replacement in severe aortic regurgitation for valve jumping up to ascending aorta: a case report.

Similar Datasets

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