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Published on: December 11, 2017
Redo Transcatheter Aortic Valve Replacement for Migration of Myval Transcatheter Heart Valve in Pure Aortic
Emmanuel Gall1, Thomas Hovasse2, Fabien Doguet2
1Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France; Department of Cardiology, University Hospital of Lariboisiere, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris-Cité, Paris, France; Inserm MASCOT - UMRS 942, University Hospital of Lariboisiere, Paris, France; MIRACL.ai Laboratory, Multimodality Imaging for Research and Artificial Intelligence Core Laboratory, University Hospital of Lariboisiere (AP-HP), Paris, France.
Background:
A 76-year-old patient with severe symptomatic aortic regurgitation, deemed inoperable, was referred for transcatheter aortic valve replacement.
Case Summary:
Preprocedural computed tomography revealed a large, noncalcified native aortic annulus (31.7 mm), making commercially available transcatheter heart valves (THVs) unsuitable. A 32-mm (+2 mL) Myval (Meril) THV was implanted with satisfactory immediate results. However, at day 7, delayed and asymptomatic migration into the left ventricular outflow tract with severe paravalvular leak occurred. Given surgical ineligibility, a 29-mm (+6 cc THV balloon overfilling) Sapien 3 (Edwards Lifesciences) THV was successfully deployed as a redo TAVR strategy, anchoring the migrated index THV. One-month follow-up showed excellent outcomes.
Discussion:
Delayed THV migration in patients with native aortic regurgitation is a challenge. This case highlights redo TAVR as a viable rescue strategy, using multimodal imaging and precise procedural techniques.
Take-Home Message:
Redo TAVR is a safe and effective approach to address late THV migration into the left ventricular outflow tract in selected patients.
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