Dataset Information

First successful transcatheter valve-in-valve implantation into a failed mechanical prosthetic aortic valve facilitated by fracturing of the leaflets: a case report.

ABSTRACT:

Background

Degenerated and failed bioprosthetic cardiac valves can safely be treated with transcatheter valve-in-valve implantation in patients at high risk for reoperation. So far, non-functional mechanical valves must be treated with a surgical redo. Breaking the carbon leaflets before implanting a transcatheter valve into the remaining ring has never been described before.

Case summary

Here, we present the case of a 65-year-old male patient with severe heart failure, poor left ventricular function based on a fully immobile disc of his mechanical bileaflet aortic valve implanted 7 years ago. After the heart team declined to reoperate the patient due to his extremely high risk, we considered a transcatheter valve-in-valve implantation as the ultimate treatment approach. After successful interventional cracking of the leaflets in vitro, this approach, together with implanting a balloon-expandable transcatheter aortic valve replacement (TAVR) into the remaining ring, was performed under cerebral protection. The intervention resulted in a fully functional TAVR, improvement of heart function, and early discharge from the hospital.

Discussion

This case demonstrates the possibility to implant a transcatheter valve successfully into a non-functional mechanical bileaflet aortic prosthesis after fracturing the carbon discs while the brain is protected by a filter system. Critical steps of the procedure were identified. This new therapeutic approach might be offered to a limited patient cohort who is not eligible for a surgical redo.

SUBMITTER: Butter C

PROVIDER: S-EPMC8323064 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundTranscatheter aortic valve implantation (TAVI) is an alternative method to treat patients with severe aortic valve disease. Accurate measurement of the aortic valve annulus and selection of the appropriate artificial valve are critical to the success of TAVI. Multilayer spiral computed tomography (MSCT) is recommended as the "gold standard" for assessing the aortic valve annulus before TAVI. However, MSCT scanning may not be possible for patients with iodine allergy, renal failure, or pregnancy. The purpose of this study is to evaluate the aortic valve annulus by three-dimensional transesophageal echocardiography (3D-TEE) and compare the results with MSCT, exploring the feasibility of 3D-TEE to guide the selection of artificial valve implantation in TAVI.MethodsWe retrospectively analyzed 74 patients who successfully underwent TAVI in our hospital. Before the operation, 3D-TEE and MSCT were used to measure the maximum diameter, minimum diameter, area-derived diameter, and perimeter-derived diameter of the aortic valve annulus, and the results were analyzed for consistency. To predict the valve size based on 3D-TEE and the MSCT area-derived diameter, we compared the differences between the predicted valve size and the actual implanted valve size, and analyzed the differences between 3D-TEE and MSCT for guiding the selection of the prosthetic valve size.ResultsThere was no significant difference between 3D-TEE and MSCT in the measurement of the maximum diameter, minimum diameter, area, and perimeter of the aortic annulus and their derived diameter (P>0.05). The intraclass correlation coefficients for the maximum diameter, minimum diameter, area-derived diameter, and perimeter-derived diameter of the aortic annulus were 0.89, 0.83, 0.84, and 0.92, respectively. There was no statistical difference in the accuracy of both methods, 3D-TEE and MSCT, in predicting different prosthetic valve sizes for TAVI (P>0.05).Conclusions3D-TEE and MSCT have good agreement for measuring the values of various parameters of the aortic annulus. The accuracy of both methods was similar for predicting the aortic prosthetic valve size. 3D-TEE may provide guidance for selecting the prosthetic valve size for TAVI.