Transcatheter Edwards Sapien XT valve in valve implantation in degenerated aortic bioprostheses via transfemoral access

Objectives

Surgical treatment of degenerated aortic bioprostheses is associated with an increased risk of morbidity and mortality, especially in elderly patients with significant co-morbidities. Therefore, transcatheter aortic valve implantation (TAVI) performed as valve in valve technique appears as an attractive alternative treatment option. We report of a case series of seven patients with dysfunctional bioprosthetic aortic heart valves who have been treated with TAVI via transfemoral access.

Methods and results

Valve in valve implantation using the Edwards Sapien XT bioprostheses (Edwards Lifesciences LLC, Irvine, CA, USA) was performed in eight patients (3 men, 5 women, mean age 85.3?±?6.1?years) with a high operative risk (logistic euroSCORE 27.2?±?7.3). Six patients underwent TAVI because of high grade stenosis of the aortic bioprostheses, whereas two patients presented with high grade regurgitation. All patients suffered at least from NYHA class III dyspnea during admission. TAVI was successfully performed via transfemoral access under local anesthesia with mild analgesic medication in all cases. Mild aortic regurgitation occurred in three patients while no permanent pacemaker implantation was required. Major cardiac events or cerebrovascular events did not occur. One aneurysm spurium, with the need of one blood transfusion, occurred. All patients improved at least one NYHA class within 30?days.

Conclusion

TAVI for degenerated aortic bioprostheses, using the Edwards Sapien XT valve via transfemoral access is a feasible option for patients at high surgical risk.     

Sleep-disordered breathing in patients undergoing transfemoral aortic valve implantation for severe aortic stenosis

Background

We examined the prevalence of sleep-disordered breathing (SDB) in patients with severe aortic valve stenosis (AS) and the impact of transfemoral aortic valve implantation (TAVI) on SDB.

Methods

79 patients underwent cardiorespiratory polygraphy (PG) before TAVI (CoreValve?), 62 of them a second PG after the procedure.

Results

Forty-nine (62 %) patients had obstructive sleep apnea (OSA), 25 (32 %) central sleep apnea (CSA), and 5 (6 %) presented without significant SDB (apnea–hypopnea index (AHI) < 5/h). Among the 62 patients evaluated before and after TAVI, 36 (58 %) had OSA, 22 (36 %) CSA, and 4 patients (7 %) no SDB. AHI was significantly higher in CSA patients than in OSA patients (34.5 ± 18.3 vs. 18.0 ± 12.6/h, p < 0.001). Successful TAVI had a significant impact on CSA but not on OSA: CSA patients with optimal TAVI results experienced a significant reduction in central respiratory events (AHI 39.6 ± 19.6–23.1 ± 16.0/h, p = 0.035), while no changes were detected in OSA patients (AHI 18.8 ± 13.0–20.25 ± 13.4/h, p = 0.376). In contrast, in patients who developed at least moderate periprosthetic aortic regurgitation (AR > I), CSA increased significantly (AHI 26.3 ± 13.2–39.2 ± 18.4/h, p = 0.036), whereas no acute change was seen in patients with OSA (AHI 10.5 ± 7.8–12.5 ± 5.0/h, p = 0.5).

Conclusion

OSA and CSA are prevalent in more than 90 % of patients undergoing TAVI for severe aortic valve stenosis. Successful TAVI had no significant impact on OSA but improved CSA. In case of an acute change from pressure overload (aortic stenosis) to acute volume overload (aortic regurgitation after TAVI), central, but not obstructive, sleep apnea deteriorated.     

经心尖途径经导管主动脉瓣置换术救治单纯性主动脉瓣重度反流1例

目的 探讨经心尖途径经导管主动脉瓣置换术治疗单纯性主动脉瓣关闭不全的可行性.方法 回顾性分析2016年9月8日浙江大学医学院附属第二医院心脏中心开展的浙江省首例经心尖途径经导管主动脉瓣置换术的术前评估、术中操作以及患者术后情况.结果 患者严格进行术前评估,术中行全身麻醉、气管插管,透视下定位后第五肋间小切口进胸,打开心包,选择心尖裸区预置荷包,穿刺后导入超滑泥鳅导丝跨过主动脉瓣到达降主动脉,导入J-Valve输送系统逐步释放,经食道超声心动图评估主动脉瓣反流从术前的大量到瓣膜释放后无反流,撤出瓣膜输送系统,手术成功结束.术后患者症状明显缓解,出现Ⅰ度房室传导阻滞,未发生死亡、心肌梗死、心包填塞、动脉夹层等并发症.结论 经心尖途径经导管主动脉瓣置换术是安全可行的,患者的远期预后还有待进一步观察.     

Transcatheter valve-in-valve implantation for degenerated mitral valve bioprosthesis under 3D echocardiographic guidance

Transcatheter mitral valve-in-valve replacement is increasingly being performed as operator and center experience in transcatheter valve replacement technology and techniques have accrued. Complications, such as valve embolization and paravalvular regurgitation, still occur and relate to valve deployment. The use of novel imaging techniques, such as 3D echocardiography, allows for better differentiation of cardiac structures and appropriate positioning of the transcatheter valve using well-visualized anatomical landmarks. Here the authors describe in images and video the use of 3D echocardiography for deployment of a mitral valve-in-valve.     

Cardiac arrest associated with aortic valve regurgitation

Blunt chest trauma can cause not only damage to the thoracic cage, but can also injure intracardiac structures including the papillary muscles, chordae tendineae, and valve leaflets. Aortic valve (AV) injury secondary to blunt chest trauma is a rare occurrence. Clinically, AV injury may be missed during the initial post-trauma assessment due to the lack of suspicion of cardiac involvement. Thus, the diagnosis of AV injury is often delayed or missed for a time interval of days to months. As a consequence, the traumatic AV regurgitation can rapidly or progressively lead to congestive heart failure unless surgically corrected. Therefore, emergency physicians should be aware of the possibility of intracardiac structure injury, such as valvular injuries, after blunt chest trauma. Guidelines for the appropriate use of bedside cardiac ultrasound (BCU) recommend BCU should be performed in all patients with new murmurs for clinically significant valvular lesions that could potentially change management.We described the case of a 73-year-old female patient with AV injury after blunt trauma. She experienced cardiac arrest (CA) secondary to a moderate-to-severe traumatic AR, which was successfully treated with emergency AV replacement. We discuss how to diagnose and manage a CA patient, aided by BCU, with ventricular failure associated with persistent AV regurgitation. To the best of our knowledge, this is the first case report on CA associated with isolated rupture of bicuspid AV rupture and AV regurgitation secondary to blunt chest trauma because of the lack of early suspicion of AV injury.     

Transcatheter CoreValve valve‐in‐valve implantation in a stentless porcine aortic valve for severe aortic regurgitation

We describe the first valve‐in‐valve Corevalve transcatheter aortic valve replacement in the St. Jude Toronto stentless porcine aortic valve in the United States, which enabled this 59‐year‐old patient with a history of bacterial endocarditis and aortic regurgitation to avoid heart transplant with complete resolution of his severe left ventricular dysfunction.     

Another step in transcatheter aortic valve implantation: A challenging transcatheter aortic valve implantation procedure in patient with severe peripheral arterial disease

Approximately 25% of patients undergoing transcatheter aortic valve implantation presents significant peripheral arterial disease. The purpose of this case report was to present a feasible approach for transcatheter heart valve in a patient with peripheral arterial disease where the presence of a subclavian stent jutting in the aortic arch made the delivery system passage a challenging procedure.     

Contained aortic annulus rupture with persisting false aneurysm after transfemoral transcatheter aortic valve implantation

With older age and increasing comorbidities, conventional operative procedures for severe symptomatic aortic stenosis are associated with a high surgical risk. To date, transfemoral transcatheter aortic valve implantation (TF-TAVI) represents an accepted alternative method of intervention with a cardiovascular and all-cause mortality similar to operative replacement at early and long-term follow-up in this high risk population (Thomas et al., Circulation 124:425–433, 2011). Despite growing experience of the operators and improvement of the devices procedural and perioperative complications still occur (Panchal et al., Am J Cardiol, 2013). Aortic annulus rupture as well as the rupture of the membranous ventricular septum has been reported (Aminian et al., Catheter Cardiovasc Interv 81:E72–E75, 2013). We present the unusual case of an 80-year-old female who developed a false aneurysm following a contained aortic annulus rupture during a TF-TAVI procedure.     

经导管主动脉瓣置入术治疗重度主动脉瓣狭窄患者的护理

目的探讨经导管主动脉瓣植入术治疗主动脉瓣重度狭窄患者的术后护理体会。方法对7例主动脉瓣重度狭窄的患者在经导管主动脉瓣植入术后进行有效、正确的护理。结果 7例患者中,6例预后良好。结论临床中经导管主动脉瓣植入术治疗主动脉瓣重度狭窄患者值得推荐,术后有效、正确的护理是确保手术成功的关键。     

Feasibility of sheathless transfemoral aortic valve implantation in patients with small access vessel diameters

Objectives

We intended to show feasibility of sheathless transfemoral aortic valve implantation in patients with small access vessel diameters.

Background

Transcatheter aortic valve implantation (TAVI) has emerged as a valid treatment option in patients with aortic valve stenosis who are poor candidates for surgical aortic valve replacement. Few patients, who cannot undergo transfemoral or transsubclavian aortic valve implantation due to small access vessel diameters, are not suitable for transapical or direct aortic valve implantation, either.

Methods

In more than 700 transcatheter aortic valve implantations since 2008 we identified 17 patients who had to be excluded from transfemoral valve implantation due to vessel diameters <6 mm and who were no candidates for transapical or direct aortic implantation. We performed CoreValve? implantations in these patients without the required 18F sheath to cross the vessels despite their small size (4.6–5.9 mm).

Results

Sixteen sheathless implantations were successful. In all 17 patients, bleeding during the procedure due to the smaller delivery catheter was minimal. Sixteen patients had a successful access site closure at the end of the procedure.

Conclusions

Sheathless implantation of a self-expanding aortic valve can be safely considered in selected patients with access vessel diameters below 6 mm, if transapical or direct aortic implantation is not suitable.     

Transcatheter aortic valve implantation in a 54-year-old patient with aggressive HIV

We report a case of a 54-year-old patient who was denied surgical replacement for severe aortic stenosis because of complicated acquired immunodeficiency syndrome and who successfully underwent transcatheter aortic valve implantation at our institution.     

Modular aortic valve prosthesis for transcatheter aortic valve implantation: a novel concept with a new implantation method

Transcatheter aortic valve implantation (TAVI) is a relatively new medical intervention. Research on dedicated TAVI devices is an exciting and dynamic field to be explored by professionals involved in technological innovation. The authors describe in this article the first engineering concept and part of the US Patent of a new valve prosthesis. Divided into two pieces to be separately implanted using a single catheter by means of an innovative technique, this device aims at reducing prosthesis and delivery catheter profile. Miniaturization of the valve and delivery system is probably the best solution to reduce the morbidity and mortality that derive from vascular complications associated with TAVI.     

Guidewire pacing during transcatheter aortic valve implantation in a patient with complex congenital heart disease

We present a case of temporary guidewire pacing in a patient with Fontan anatomy during transcatheter aortic valve implantation. Temporary pacing was successfully achieved utilizing this method without complications. There is an increasing population of patients with complex congenital heart disease and expanding variety of transcatheter interventions. Due to limitations in vascular access and surgical anatomies, guidewire pacing may have a wide array of potential applications in pediatrics and the congenital heart disease population.     

Quadricuspid aortic valve associated with aortic stenosis and regurgitation: report of a case and a review of the literature

Quadricuspid aortic valve (QAV) is a rare congenital heart valve disease, and more than half of QAV patients have severe aortic regurgitation (AR). We describe the case of a 66-year-old woman with QAV detected by transthoracic echocardiography during a medical checkup. Doppler echocardiographic examination showed mild aortic stenosis and mild AR. The patient has been under routine medical review without medication therapy. At follow-up echocardiographic examinations over a 4-year period, no significant changes in severity of aortic stenosis or AR were found. The clinical and functional characteristics of 192 cases of QAV were reviewed. The functional status of the QAV was known in 144 cases; of these, only 13 (9%) had both aortic stenosis and AR.