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First percutaneous transcatheter aortic valve-in-valve implant with three year follow-up
Carlos E Ruiz1, Jean C Laborde, Jose F Condado
1Department of Cardiac and Vascular Interventional Services, Lenox Hill Heart and Vascular Institute of New York, New York, USA. cruiz@lenoxhill.net
Insights
This case study shows a successful three-year outcome for a patient receiving a second transcatheter aortic valve implantation (TAVI) procedure. The novel valve-in-valve approach demonstrated durability and improved patient function.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomaterials Science
Background:
- Severe symptomatic aortic stenosis (AS) and aortic regurgitation (AR) pose significant challenges.
- Long-term durability of percutaneous heart valve (PHV) implantation remains an area of investigation.
- The feasibility of a PHV-in-PHV procedure for degenerated surgical bioprostheses has not been established.
Observation:
- A patient with severe refractory heart failure underwent a CoreValve prosthesis implantation for severe AR and moderate AS.
- The initial PHV deployment was suboptimal, resulting in severe AR.
- A second CoreValve was successfully deployed in a valve-in-valve configuration, effectively treating the regurgitation.
Findings:
- The CoreValve-in-CoreValve system demonstrated proper function with no structural deterioration or migration at three years.
- Transvalvular gradients remained within acceptable limits (8 mmHg initially, 10 mmHg at 3 years).
- The patient's functional class improved significantly from NYHA IV to II, sustained over three years.
Implications:
- This case demonstrates the feasibility and durability of the PHV-in-PHV approach for treating complex aortic valve disease.
- The CoreValve prosthesis shows sustained function up to three years in a valve-in-valve scenario.
- This technique offers a potential solution for patients with degenerated surgical bioprostheses and severe AR.
Objectives:
This study was conducted to report the clinical, hemodynamic, and iconographic outcomes of the longest survivor of the global CoreValve experience.
Background:
Early results of percutaneous heart valve (PHV) implantation for severe symptomatic aortic stenosis (AS) have been encouraging, with mid term survival up to 2 years; however longer durability term is unknown. Although a PHV has been implanted in a degenerated surgical bioprosthesis, the feasibility of a PHV-in-PHV has not been demonstrated.
Methods:
A patient with severe refractory heart failure due to severe aortic regurgitation (AR) and moderate AS, underwent CoreValve prosthesis implantation. The PHV was deployed too proximal into the left ventricular outflow tract, resulting in severe AR through the frame struts. Using the first PHV as a landmark, a second CoreValve was then deployed slightly distal to the first, with trivial residual paravalvular leak.
Results:
The second CoreValve expanded well with proper function. Transvalvular gradient was 8 mmHg. Both coronary ostia were patent. New mild to moderate mitral regurgitation occurred due to impingement of the anterior mitral leaflet by the first PHV. NYHA functional class improved from IV to II, maintained over the past 3 years. Echocardiography at 3 years showed normal functioning CoreValve-in-CoreValve prostheses, without AR or paravalvular leaks. Transvalvular gradient was 10 mmHg. Cardiac CT showed stable valve-in-valve protheses with no migration.
Conclusion:
The CoreValve prosthesis has maintained proper function up to 3 years, with no structural deterioration or migration. Treating mixed aortic valve disease with predominant AR is feasible. The concept as well as durability of the first PHV-in-PHV has also been demonstrated.
