Thorac Cardiovasc Surg 2018; 66(S 01): S1-S110
DOI: 10.1055/s-0038-1628045
Oral Presentations
Tuesday, February 20, 2018
DGTHG: Catheter-based Valvular Therapies - TAVI I
Georg Thieme Verlag KG Stuttgart · New York

Valve-in-Valve Procedures in a Biological Xenograft with Externally Mounted Leaflets: What Is the True Procedural Risk?

Y. Schneeberger
1   Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
,
N. Neumann
1   Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
,
A. Schäfer
1   Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
,
N. Schofer
2   Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
,
F. Deuschl
2   Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
,
J. Schirmer
1   Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
,
S. Blankenberg
2   Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
,
H. Reichenspurner
1   Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
,
U. Schäfer
2   Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
,
L. Conradi
1   Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
22 January 2018 (online)

 
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    Objectives: Valve-in-valve (ViV) procedures using transcatheter heart valves (THV) in cases of structural valve deterioration (SVD) of aortic xenografts are an established alternative to surgical redo valve replacement in high- and intermediate risk patients. The Mitroflow aortic valve (LivaNova PLC, London, UK) is known to carry a certain risk of coronary ostia occlusion due to possible lateral displacement of externally mounted leaflets during ViV. We present our experience with ViV procedures in this particular valve.

    Methods: From 10/2012 to 12/2015 14 consecutive patients (75% female, 78.6 ± 7.4 years, log EuroSCORE I 29.8 ± 14.1%) received ViV procedures for SVD, time interval to surgical index procedure was 5.8 ± 2.4 years. Utilized THV were Medtronic CoreValve in 2/14, Medtronic CoreValve EvolutR (Medtronic, Inc., Minneapolis, MN, USA) in 10/14 patients and JenaValve (JenaValve Technology Inc, Irvine, CA, US) in 2/14 patients. Data were retrospectively analyzed according to updated Valve Academic Research Consortium (VARC-2) definitions.

    Results: Device success was 64.2% (9/14) due to one THV embolization with subsequent transapical THV implantation and four increased postprocedural mean pressure gradients > 20 mm Hg. All-cause 30-day mortality was 0% (0/14). In 10 patients (71.4%) take-off height of the left main was >10 mm requiring prewiring of coronary arteries. No coronary occlusion with subsequent coronary intervention was registered. Resultant transvalvular peak/mean gradients and effective orifice area were 33.7 ± 22.2/21.3 ± 14.2 mm Hg and 1.4 ± 0.2 cm2, in 28.5% (4/14) mean transvalvular gradient was > 20 mm Hg. PVL ≥ mild was observed in 7.1% (1/14). Rate of PPM implantation was 7.1% (1/14). Early safety was 92.8% (13/14) due to one THV embolization. In 6/14 patients (42.8%) a cerebral protection system was used. No stroke occurred.

    Conclusion: ViV procedures for early SVD of the Mitroflow bioprosthesis are safe and feasible when certain risks for complications and unintended THV performance are considered. Coronary pre-wiring and PCI stand-by is recommended in cases of low coronary ostia take-off. An interdisciplinary heart team is mandatory for planning and performance of these complex procedures to guarantee optimal patient safety.


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    No conflict of interest has been declared by the author(s).

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