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Transcatheter valve-in-valve implantation using Corevalve Revalving System for failed surgical aortic bioprostheses

Francesco Bedogni1, Maria Luisa Laudisa, Samuele Pizzocri

  • 1Istituto Clinico S. Ambrogio, Department of Interventional Cardiology, Milan, Italy.

JACC. Cardiovascular Interventions
|November 26, 2011
PubMed

Insights

Transcatheter aortic valve implantation using the CoreValve Revalving System (CRS) is effective for patients with failed bioprostheses. This valve-in-valve procedure offers a feasible treatment option for high-risk individuals unsuitable for surgical redo.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Transcatheter aortic valve implantation (TAVI) with the CoreValve Revalving System (CRS) is a viable treatment for high-risk patients with severe aortic stenosis.
  • CRS TAVI may be a suitable alternative for patients with a failed aortic bioprosthesis, particularly when surgical redo carries prohibitive risks.

Purpose of the Study:

  • To evaluate the performance and outcomes of CoreValve Revalving System (CRS) implantation in patients with previously implanted failed aortic bioprostheses.
  • To assess the feasibility and efficacy of the valve-in-valve procedure for managing failed bioprosthetic valves in high-risk surgical candidates.

Main Methods:

  • A cohort of 25 high-risk patients with failed bioprosthetic aortic valves underwent CRS valve-in-valve implantation.
  • Patients were categorized into Type A (predominantly stenosis) and Type B (predominantly regurgitation) based on the mode of bioprosthesis failure.
  • Demographic and clinical data, including age, New York Heart Association (NYHA) functional class, logistic EuroSCORE, and Society of Thoracic Surgeons (STS) score, were collected.

Main Results:

  • The implantation success rate was 100%, with significant reduction in mean aortic gradient in Type A patients (77.6 to 34.6 mm Hg).
  • Post-implantation, significant regurgitation was absent in most Type B patients. No procedural mortality occurred.
  • At 30 days, complications included 3 deaths (12%), 2 myocardial infarctions (8%), and 3 atrioventricular blocks requiring pacemakers (12%). At 6 months, survival was 84% with a cumulative pacemaker incidence of 16%.

Conclusions:

  • CoreValve Revalving System (CRS) implantation is a feasible and effective treatment for failed aortic bioprostheses, irrespective of the primary failure mode (stenosis or regurgitation).
  • This valve-in-valve approach offers a significant therapeutic option for patients with failed bioprostheses who are at prohibitive risk for conventional surgical reoperation.
Abstract

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