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Unique technical challenges in patients undergoing TAVR for failed aortic homografts
Olga N Kislitsina1,2, Michal Szlapka1, Patrick M McCarthy1
1Divisions of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA.
Journal of Cardiac Surgery
|November 10, 2020
Summary
Transcatheter aortic valve replacement (TAVR) is a safe alternative for patients with degenerated aortic homografts. Precise device placement is key to preventing complications and repeat interventions.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Prosthetic Valve Disease
Background:
- Surgical reoperation for aortic homograft structural valve degeneration (SVD) carries high risks.
- Transcatheter aortic valve replacement (TAVR) presents an alternative to surgical reintervention for homograft SVD.
- Limited data exists on TAVR implantation techniques for failed aortic homografts.
Purpose of the Study:
- To compare outcomes of TAVR in patients with failed aortic homografts (TAVR-H) versus failed stented bioprostheses (TAVR-BP).
- To evaluate the safety and feasibility of TAVR as an alternative to high-risk surgical reoperation for aortic homograft SVD.
Main Methods:
- Retrospective analysis of 41 patients undergoing TAVR for SVD between 2015-2017.
- Patients were divided into TAVR-H (n=8) and TAVR-BP (n=33) groups.
- Outcomes were reported using Valve Academic Research Consortium criteria.
Main Results:
- TAVR-BP patients predominantly had stenosis (94%), while TAVR-H patients mostly had regurgitation (88%).
- TAVR-H involved specific device placements (Sapien-3, XT; CoreValve) with 40% ventricular fixation.
- Zero 30-day mortality, stroke, or pacemaker implantation occurred in both groups; some device migration events were noted.
Conclusions:
- TAVR is a feasible and safe option for failing aortic homografts, avoiding high-risk surgery.
- Accurate 40% ventricular device positioning is critical for preventing paravalvular leak and prosthesis migration.
- This technique minimizes risks associated with repeat surgical interventions.
