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Trans-catheter aortic valve implantation after previous aortic homograft surgery
Thorsten Drews1, Miralem Pasic, Semih Buz
1Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Insights
Trans-catheter aortic valve implantation is a viable option for patients needing aortic valve re-operations after homograft implantation. This minimally invasive procedure demonstrated success in high-risk patients, with careful positioning crucial for optimal outcomes.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Conventional aortic valve re-operations carry elevated risks in patients with prior heart surgery.
- Trans-catheter aortic valve implantation (TAVI) offers a less invasive alternative for high-risk individuals.
- Previous homograft implantation presents unique challenges for TAVI procedures.
Observation:
- The study evaluated 345 patients undergoing trans-apical aortic valve implantation (TA-TAVI).
- Three patients with prior aortic homograft implantation required re-operation due to homograft degeneration.
- TA-TAVI was successfully performed in all three patients with previous homografts.
Findings:
- Successful implantation of the aortic valve was achieved in all three patients with prior homografts.
- Minor paravalvular leakage was noted in two patients; central leakage in one.
- No instances of coronary ostium obstruction or mitral valve damage were observed.
Implications:
- Trans-catheter valve implantation is feasible and effective in patients with previous aortic homograft implantation.
- Meticulous attention to valve positioning is essential to avoid coronary ostium obstruction and annulus rupture.
- TA-TAVI represents a promising treatment option for selected patients with degenerated aortic homografts.
Abstract:
In patients with previous heart surgery, the operative risk is elevated during conventional aortic valve re-operations. Trans-catheter aortic valve implantation is a new method for the treatment of high-risk patients. Nevertheless, this new procedure carries potential risks in patients with previous homograft implantation in aortic position. Between April 2008 and February 2011, 345 consecutive patients (mean EuroSCORE (European System for Cardiac Operative Risk Evaluation): 38 ± 20%; mean Society of Thoracic Surgeons (STS) Mortality Score: 19 ± 16%; mean age: 80 ± 8 years; 111 men and 234 women) underwent trans-apical aortic valve implantation. In three patients, previous aortic homograft implantation had been performed. Homograft degeneration causing combined valve stenosis and incompetence made re-operation necessary. In all three patients, the aortic valve could be implanted using the trans-apical approach, and the procedure was successful. In two patients, there was slight paravalvular leakage of the aortic prosthesis and the other patient had slight central leakage. Neither ostium obstruction nor mitral valve damage was observed. Trans-catheter valve implantation can be performed successfully after previous homograft implantation. Particular care should be taken to achieve optimal valve positioning, not to obstruct the ostium of the coronary vessels due to the changed anatomic situation and not to cause annulus rupture.
