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Innovative Approach to Manage Transcatheter Aortic Valve Embolization

ABSTRACT: We describe the case of a patient with an ascending aortic aneurysm who underwent valve-in-valve transcatheter aortic valve implantation, which was complicated by valve embolization. After a multidisciplinary discussion and an innovative approach, the free-floating embolized valve was anchored securely in the aortic arch with an uncovered aortic endovascular stent. (Level of Difficulty: Intermediate.) Central Illustration

SUBMITTER: Keeton J

PROVIDER: S-EPMC9911928 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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A case report of open-aorta, direct transcatheter valve-in-valve implantation: an innovative approach to manage the hazard of coronary flow compromise in transcatheter aortic valve re-interventions.

Project description:BackgroundCoronary flow compromise is a significant risk of transcatheter aortic valve therapy. Warranting preservation of coronary flow is even more challenging with transcatheter aortic valve re-intervention since the implantation of a transcatheter valve within a degenerated bioprosthetic or transcatheter valve increases significantly this hazard.Case summaryWe present a case of heart failure secondary to transcatheter aortic valve degeneration requiring a transcatheter aortic valve re-intervention. Pre-operative imaging studies demonstrated a high risk for iatrogenic coronary flow impairment. The patient underwent a successful surgical removal of the prosthetic valve leaflets followed by direct transcatheter aortic valve implantation.ConclusionWe reviewed the literature on the approach to difficult coronaries in transcatheter aortic valve therapy, and we describe an innovative hybrid approach that may represent a viable alternative in cases where catheter techniques of coronary flow preservation are not applicable.

| S-EPMC8189306 | biostudies-literature

Surgical Bailout of Transcatheter Aortic Valve Embolization Using a Right Anterior Minithoracotomy Approach.

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| S-EPMC11393425 | biostudies-literature

Embolization of aortic valve leaflet during valve-in-valve transcatheter aortic valve implantation: a case report.

Project description:BackgroundAortic stenosis (AS) is one of the most common valvular disorders worldwide. An increasing number of transcatheter aortic valve implantation (TAVI) procedures are being performed yearly for managing AS. This, along with the occurrence of common complications, makes timely diagnosis essential to manage rare complications and improve patient outcomes.Case summaryWe present a case of a 77-year-old Caucasian male with severe AS with a dysfunctional bioprosthetic valve following previous surgical valve replacement. During valve-in-valve TAVI, we noted bioprosthetic valve leaflet avulsion and embolization causing a major vascular occlusion that resulted in vascular insufficiency of the left lower extremity. This condition was managed successfully via immediate diagnosis using transoesophageal echocardiogram, angiogram, and vascular surgical intervention for retrieving the embolized valve to re-establish circulation.DiscussionTo our knowledge, this is the first case of aortic valve leaflet embolization during TAVI resulting in significant vascular insufficiency. Vascular complications are common during TAVI. However, not all vascular complications are the same. Our case highlights an embolic vascular complication from an avulsed prosthetic material during a challenging valve-in-valve TAVI procedure.

| S-EPMC7047047 | biostudies-literature

Successful Management of Myval Transcatheter Heart Valve Embolization Into Abdominal Aortic Aneurysm During Transcatheter Aortic Valve Replacement.

Project description:Transcatheter heart valve embolization is a serious and rare complication of transcatheter aortic valve replacement. Having a strategy for promptly managing transcatheter heart valve embolization is crucial to avoid emergency conversion from transcatheter aortic valve replacement to open-heart surgery. Many cases of transcatheter heart valve embolization occurring with balloon-expandable prostheses such as the SAPIEN 3 (Edwards LifeSciences Corporation) valve and self-expandable prostheses such as the ACURATE neo (Boston Scientific Corporation) valve have been reported in the literature. Here, for the first time (to the authors' knowledge), the case of a Myval (Meril Life Sciences Pvt Ltd) transcatheter heart valve embolization during transcatheter aortic valve replacement, which was treated percutaneously with favorable outcomes, is reported.

| S-EPMC11536086 | biostudies-literature

Transcatheter Aortic Valve Embolization in a Patient With a Left Ventricular Assist Device.

Project description: Not available

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Femoral artery anatomy-tailored approach in transcatheter aortic valve implantation.

Project description:The best techniques for reduction of femoral access site complications after transcatheter aortic valve implantation (TAVI) remain the object of research.We report on a single center's experience with TAVI performed via the femoral access site.Between September 2010 and September 2015, 152 consecutive patients underwent TAVI in our department. Of them, 101 patients with CoreValve implantation from the femoral access site were included in the analysis. The femoral artery anatomy-tailored approach was introduced in 2013 in order to reduce the rate of access-site complications. Patients were assigned to percutaneous puncture or surgical cut-down depending on the femoral artery anatomy assessed in computed tomography. The study patients were divided into two subgroups: group A - patients treated before January 2013, before introduction of the tailored approach program (n = 34); and group B - patients treated between January 2013 and April 2015 (n = 67).The access site complication rate significantly decreased from 35.3% in group A (n = 12) to 7.5% in group B (n = 5) (p = 0.0012). Both minor and major access site complications were more frequent in group A (p = 0.04 and 0.016, respectively). In-hospital mortality was 8.8% (n = 3) in group A and 1.5% (n = 1) in group B (p = 0.1).The femoral artery anatomy-tailored approach significantly reduces the incidence of access site complications in TAVI patients.

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Use of a Bare Metal Dissection Stent to Manage Aortic Embolization of a Self-Expanding Valve.

Project description:BackgroundThis paper describes a case of prosthesis embolization during transcatheter aortic valve replacement (TAVR) that was managed with a novel percutaneous strategy.Case summaryA 77-year-old man with severe trileaflet aortic valve stenosis underwent TAVR with a 29-mm Evolut FX. The valve embolized to the ascending aorta shortly after its release. TAVR was completed with a 23-mm SAPIEN 3 Ultra RESILIA, and a Zenith Dissection Endovascular Stent was deployed through the embolized Evolut FX, pinning the prosthesis to the aortic wall. The patient experienced no neurologic or aortic injury through 30 days of follow-up.DiscussionBecause of its use in complicated type B aortic dissection, the bare metal dissection stent is an excellent option for managing embolized prostheses that cannot be repositioned in the descending aorta.Take-home messageDeployment of a bare metal dissection stent may be an important rescue strategy for embolized TAVR prostheses.

| S-EPMC11830251 | biostudies-literature

Midterm Degeneration of Transcatheter Heart Valve Device following Valve-in-Valve Transcatheter Aortic Valve Replacement Requiring Repeat Transcatheter Aortic Valve Replacement.

Project description: Not available

| S-EPMC7451866 | biostudies-literature

A valve-in-valve (ViV) transcatheter aortic valve implantation with lithotripsy-assisted transfemoral approach.

Project description: Not available

| S-EPMC7649463 | biostudies-literature

Transcatheter Aortic Valve Implantation for Bioprosthetic Valve Failure: Placement of Aortic Transcatheter Valves 3 Aortic Valve-in-Valve Study.

Project description:BackgroundTranscatheter aortic valve implantation is safe and effective for high-risk patients with bioprosthetic valve failure (BVF) but has not been studied in low- and intermediate-risk patients. One year outcomes of the PARTNER 3 Aortic Valve-in-valve (AViV) Study were evaluated.MethodsThis prospective, single-arm, multicenter study enrolled 100 patients from 29 sites with surgical BVF. The primary endpoint was a composite of all-cause mortality and stroke at 1 year. The key secondary outcomes included mean gradient, functional capacity, and rehospitalization (valve-related, procedure-related, or heart failure related).ResultsA total of 97 patients underwent AViV with a balloon-expandable valve from 2017 to 2019. Patients were 79.4% male with a mean age of 67.1 years and Society of Thoracic Surgeons score of 2.9%. The primary endpoint occurred in 2 patients (2.1%) who had strokes; there was no mortality at 1 year. Five patients (5.2%) had valve thrombosis events, and 9 patients (9.3%) had rehospitalizations, including 2 (2.1%) for strokes, 1 (1.0%) for heart failure, and 6 (6.2%) for aortic valve reinterventions (3 explants, 3 balloon dilations, and 1 percutaneous paravalvular regurgitation closure). From baseline to 1 year, New York Heart Association class III/IV decreased from 43.3% to 4.5%, mean gradient from 39.1 ± 18.2 mm Hg to 19.7 ± 7.6 mm Hg, and ≥moderate aortic regurgitation from 41.1% to 1.1%.ConclusionsAViV with a balloon-expandable valve improved hemodynamic and functional status at 1 year and can provide an additional therapeutic option in selected low- or intermediate-risk patients with surgical BVF, although longer term follow-up is necessary.

| S-EPMC10242574 | biostudies-literature

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