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Aortic valve replacement using valve-in-valve procedure in a patient with left atrial appendage thrombus

Mehmet Erdoğan1, Engin Bozkurt2

  • 1Department of Cardiology, Ankara City Hospital, Ankara, Turkey.

Turk Gogus Kalp Damar Cerrahisi Dergisi
|March 17, 2020
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) is increasingly used in older patients. This study demonstrates that valve-in-valve TAVR is feasible even with a left atrial appendage thrombus, a common exclusion criterion.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Transcatheter aortic valve replacement (TAVR) indications and patient eligibility are expanding.
  • Left atrial appendage (LAA) thrombus is typically an exclusion criterion for TAVR studies.
  • Degeneration of bioprosthetic aortic valves necessitates reintervention.

Observation:

  • An 86-year-old male presented with severe aortic stenosis due to a degenerated bioprosthetic valve.
  • Transesophageal echocardiography and contrast-enhanced CT confirmed an LAA thrombus.
  • The patient had a 22-mm bioprosthetic valve implanted 14 years prior.

Findings:

  • Successful valve-in-valve TAVR was performed despite the presence of an LAA thrombus.
  • A balloon-expandable valve was implanted into the degenerated bioprosthetic aortic valve.
  • This case highlights the potential for TAVR in complex scenarios.

Implications:

  • Valve-in-valve TAVR may be a viable option for patients with LAA thrombus.
  • This challenges current exclusion criteria in TAVR research.
  • Further studies are warranted to assess the safety and efficacy of TAVR in patients with LAA thrombi.

Keywords:
Atrial fibrillationleft atrial appendage thrombustranscatheter aortic valve replacementvalve-in-valve

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