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Bioprosthetic Valve Fracture After TAVR Complicated by Balloon Rupture: Bail-Out TAVR in TAVR in SAVR.

ABSTRACT: Transcatheter aortic valve replacement in surgical aortic valve is a safe and effective procedure to treat patients with failed bioprosthetic surgical valves at high risk for reoperation. Performing bioprosthetic valve fracture has been shown to improve postprocedural hemodynamics of TAVR in surgical aortic valve replacement. However, specific complications related to valve fracture are becoming more common. (Level of Difficulty: Advanced.).

SUBMITTER: Attisano T

PROVIDER: S-EPMC9666742 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Bioprosthetic Valve Fracture After TAVR Complicated by Balloon Rupture: Bail-Out TAVR in TAVR in SAVR.

Attisano Tiziana T Bellino Michele M Vigorito Francesco F Maione Antongiulio A Ravera Amelia A Pierri Adele A Baldi Cesare C Galasso Gennaro G Vecchione Carmine C Bonan Raoul R

JACC. Case reports 20221005 19

Transcatheter aortic valve replacement in surgical aortic valve is a safe and effective procedure to treat patients with failed bioprosthetic surgical valves at high risk for reoperation. Performing bioprosthetic valve fracture has been shown to improve postprocedural hemodynamics of TAVR in surgical aortic valve replacement. However, specific complications related to valve fracture are becoming more common. (<b>Level of Difficulty: Advanced.</b>). ...[more]

PMID: 36406923

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Bail out lithotripsy to treat delayed valve-in-valve TAVR-related coronary obstruction.

Project description:Coronary access difficulty and stent compression by the juxtaposed aortic valve leaflet hamper percutaneous management of delayed coronary artery obstruction (CAO) after valve-in-valve (Edwards Sapien 3 in St. Jude Trifecta) transcatheter aortic valve replacement (TAVR). Here, we present a case of delayed post-TAVR CAO treated with intravascular lithotripsy and multistenting to overcome stent compression by the adjacent calcified leaflet.

| S-EPMC10099844 | biostudies-literature

Mitral Valve Repair and SAVR After TAVR Complicated With Endocarditis and Mitral Valve Leaflet Perforation.

Project description:ObjectivesWe present our surgical management of a mechanical transcatheter aortic valve replacement (TAVR) complication of an anterior mitral valve leaflet (AML) perforation with infective endocarditis.Key stepsManagement consisted of surgical TAVR explantation, transaortic patch plasty of the AML perforation, patch plasty of an aortic laceration by the TAVR valve, and surgical aortic valve replacement.Potential pitfallsIn cases of high operative risk in a technically demanding surgical situation, the surgeon should aim to operate early and avoid extensive surgical trauma and long operation time by addressing the mitral valve through the aorta and choosing repair instead of replacement for AML perforation.Take-home messagesPoor positioning of TAVR valves can result in severe structural and subsequent infectious complications. Early surgical treatment in high-risk older adult patients can be successfully performed, with favorable outcomes. Scrupulous asepsis and prophylactic perioperative antibiotic therapy are the most important prophylactic measures for prosthetic valve endocarditis.

| S-EPMC11830241 | biostudies-literature

Preemptive Alcohol Septal Ablation Prior to Valve-in-Valve Transcatheter Mitral Valve Replacement With Bioprosthetic Balloon Fracture.

Project description:A 78-year-old woman with bioprosthetic mitral valve degeneration at high risk for reoperation was referred for transcatheter mitral valve replacement. We describe the use of a preemptive alcohol septal ablation pre-procedurally to minimize the risk of acute left ventricular outflow tract obstruction given the anticipated need for a bioprosthetic valve fracture. (Level of Difficulty: Advanced.).

| S-EPMC8311042 | biostudies-literature

Degenerated TAVR Within Degenerated Surgical Bioprosthetic Valve Treated With Second TAVR.

Project description:Transcatheter aortic valve replacement within a degenerated surgical bioprosthetic aortic valve is increasing in frequency. We present a rare case of a patient requiring a second TAVR placed within a previous placed degenerated transcatheter aortic valve, which was implanted in a degenerated surgical bioprosthetic aortic valve. (Level of Difficulty: Advanced.).

| S-EPMC8311726 | biostudies-literature

TAVR-in-TAVR with a balloon-expandable valve for paravalvular leak.

Project description:IntroductionParavalvular leak (PVL) is a severe complication of transcatheter aortic valve replacement (TAVR) that can lead to poor outcomes. TAVR-in-TAVR is a promising treatment for PVL; however, reports on its safety or efficacy are limited. In this study, we aimed to investigate the clinical outcomes of TAVR-in-TAVR using balloon-expandable prostheses for PVLs after TAVR.MethodsWe retrospectively analyzed data from patients who underwent TAVR-in-TAVR using balloon-expandable Sapien prostheses for PVL after an initial TAVR at our institution. The procedural success, in-hospital complications, all-cause mortality, and echocardiographic data for up to 2 years post-surgery were evaluated.ResultsIn total, 31 patients with a mean age of 81.1 ± 7.9 years and mean Society of Thoracic Surgeons score of 8.8 ± 5.4% were identified. The procedural success rate of TAVR-in-TAVR was 96.8% (30/31). No in-hospital deaths, cardiac tamponade, or conversion to sternotomy occurred. Re-intervention was performed in only one patient (3.2%) during hospitalization. The all-cause mortality rates at 30 days and 2 years were 0% and 16.1%, respectively. A significant reduction in the PVL rate was observed at 30 days compared with that at baseline (p < 0.01).DiscussionOur findings suggest that TAVR-in-TAVR using balloon-expandable prostheses is safe and effective for PVL after TAVR with low complication rates and acceptable long-term outcomes. Further studies with larger sample sizes are needed to confirm our findings.

| S-EPMC10985156 | biostudies-literature

Percutaneous Management of Aortic Root Rupture After Balloon-Expandable TAVR.

Project description:This article presents a case of aortic root rupture after transfemoral aortic valve replacement, successfully treated by a percutaneous approach, with a good evolution of the patient both during hospitalization and in the long term, being asymptomatic at the cardiovascular level after 18 months of follow-up. (Level of Difficulty: Advanced.).

| S-EPMC10715956 | biostudies-literature

A Meta-Analysis of Short-Term Outcomes of TAVR versus SAVR in Bicuspid Aortic Valve Stenosis and TAVR Results in Different Bicuspid Valve Anatomies

Project description: Not available

| S-EPMC10707011 | biostudies-literature

The Evolving Management of Aortic Valve Disease: 5-Year Trends in SAVR, TAVR, and Medical Therapy.

Project description:Aortic stenosis (AS) and regurgitation (AR) may be treated with surgical aortic valve replacement (SAVR), transcatheter AVR (TAVR), or medical therapy (MT). Data are lacking regarding the usage of SAVR, TAVR, and MT for patients hospitalized with aortic valve disease and the characteristics of the patients and hospitals associated with each therapy. From the Nationwide Readmissions Database, we determined utilization trends for SAVR, TAVR, and MT in patients with aortic valve disease admitted from 2012 to 2016 for valve replacement, heart failure, unstable angina, non-ST-elevation myocardial infarction, or syncope. We also performed multinomial logistic regressions to investigate associations between patient and hospital characteristics and treatment. Among 366,909 patients hospitalized for aortic valve disease, there was a 48.1% annual increase from 2012 through 2016. Overall, 19.9%, 6.7%, and 73.4% of patients received SAVR, TAVR, and MT, respectively. SAVR decreased from 21.9% in 2012 to 18.5% in 2016, whereas TAVR increased from 2.6% to 12.5%, and MT decreased from 75.5% to 69.0%. Older age, female sex, greater severity of illness, more admission diagnoses, not-for-profit hospitals, large hospitals, and urban teaching hospitals were associated with greater use of TAVR. In multivariable analysis, likelihood of TAVR relative to SAVR increased 4.57-fold (95% confidence interval 4.21 to 4.97). TAVR has increased at the expense of both SAVR and MT, a novel finding. However, this increase in TAVR was distributed inequitably, with certain patients more likely to receive TAVR certain hospitals more likely to provide TAVR. With the expected expansion of indications, inequitable access to TAVR must be addressed.

| S-EPMC6880229 | biostudies-literature

Comparison of Sutureless Bioprosthetic Valve With Surgical or TAVR for Severe Aortic Stenosis.

Project description:BackgroundClinical advantages of sutureless rapid-deployment (RD) aortic valve replacement (AVR) for severe aortic valve stenosis (AS) have not been elucidated compared with surgical (SAVR) or transcatheter (TAVR) aortic valve replacement.ObjectivesThis study sought to investigate comparative effectiveness and safety of RD-AVR compared with SAVR and TAVR in a prospective cohort of patients with severe AS.MethodsThe primary outcome was a composite of death, stroke, or rehospitalization at 12 months. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics.ResultsAmong 1,020 eligible patients, 107 (10.5%) underwent RD-AVR, 437 (42.8%) underwent SAVR, and 476 (46.7%) underwent TAVR. In the matched cohorts of RD-AVR and SAVR (n = 107), the incidence of primary composite outcome at 12 months was similar between the 2 groups (8.0% vs 10.8%, respectively; hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.30-1.84; P = 0.52). In the matched cohorts of RD and TAVR (n = 58), the incidence of primary composite outcome at 12 months did not statistically differ between the 2 groups (9.4% vs 16.2%, respectively; HR: 0.53; 95% CI: 0.18-1.57; P = 0.25).ConclusionsIn this propensity-matched cohort of patients who underwent AVR for severe AS, we did not detect significant differences in the rates of the primary composite of death, stroke, or rehospitalization at 12 months when comparing RD-AVR with SAVR and TAVR. Because the study was underpowered, the results should be considered as hypothesis generating highlighting the need for further research. (ASAN Medical Center Aortic Valve Replacement Registry [ASAN-AVR]; NCT03298178).

| S-EPMC9627931 | biostudies-literature

Transcatheter valve-in-valve aortic valve replacement with bioprosthetic valve Fracture/Stretching technique in a degenerated mitroflow valve.

Project description:We describe a successful bioprosthetic annular stretching in a patient with severe prosthetic aortic valve stenosis from a degenerated 19-mm Mitroflow valve (Sorin Group USA Inc, Arvada, CO, USA). This technique allowed for implantation of a 23-mm Evolut-R Pro valve (Medtronic, Minneapolis, MN, USA) with significant improvement in hemodynamics after prosthetic annular stretching. We have also summarized other case series and case reports which have previously described similar techniques. <Learning objective: Transcatheter valve-in-valve procedure may not be feasible in certain patients who have a relatively smaller size bioprosthetic valve. Cracking/stretching the annular ring of the smaller prosthetic valve to deploy a larger transcatheter valve is a potential option in these patients. Clinicians must be cognizant of the possible pitfalls, contraindications, and other technical aspects to choose the right patient for this procedure.>.

| S-EPMC7195570 | biostudies-literature

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