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Transcatheter Valve-in-Valve: A Cautionary Tale
Jessica G Y Luc1, Miriam Shanks2, Benjamin D Tyrrell3
1Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
The Annals of Thoracic Surgery
|August 24, 2016
Summary
Transcatheter aortic valve replacement (TAVR) valve-in-valve (VIV) implantation can be risky. A case of TAVR VIV into a degenerated bioprosthesis led to valve embolization and required surgical replacement.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Transcatheter aortic valve replacement (TAVR) via valve-in-valve (VIV) implantation offers an alternative for high-risk patients with degenerated bioprostheses.
- The Edwards SAPIEN XT (ESV) is a TAVR device used in VIV procedures.
Observation:
- A case involving transapical TAVR VIV using a 29-mm ESV into a 29-mm Medtronic Freestyle stentless bioprosthesis is presented.
- Unanticipated dilatation of the Freestyle bioprosthesis occurred during the procedure.
Findings:
- The dilatation led to intraprocedural embolization of the TAVR valve.
- Urgent conversion to conventional surgical aortic valve replacement (AVR) was necessary.
Implications:
- TAVR VIV with a 29-mm ESV into a degenerated 29-mm Freestyle stentless bioprosthesis requires extreme caution.
- This case highlights potential complications and the need for careful patient selection and procedural planning.
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