OBJECTIVES: This study sought to evaluate outcomes after implantation of a second transcatheter heart valve (THV-in-THV) for acute THV failure. BACKGROUND: Aortic regurgitation after transcatheter aortic valve replacement (TAVR) may be valvular due to prosthetic leaflet dysfunction or paravalvular due to poor annular sealing. METHODS: Patients undergoing aortic balloon-expandable TAVR at 3 centers were prospectively evaluated at baseline, intraprocedurally, at hospital discharge, and annually. RESULTS: Of 760 patients undergoing TAVR, 21 (2.8%) received a THV-in-THV implant due to acute, severe regurgitation. Aortic regurgitation was paravalvular in 18 patients and transvalvular in the remaining 3 patients. THV-in-THV implantation was technically successful in 19 patients (90%) and unsuccessful in 2 patients (10%), who subsequently underwent open heart surgery. Mortality at 30 days and 1 year was 14.3% and 24%, respectively. After successful THV-in-THV, mean aortic valve gradient fell from 37 ± 12 mm Hg to 13 ± 5 mm Hg (p < 0.01); aortic valve area increased from 0.64 ± 0.14 cm(2) to 1.55 ± 0.27 cm(2) (p < 0.01); and paravalvular aortic regurgitation was none in 4 patients, mild in 13 patients, and moderate in 2 patients. At 1-year follow-up, 1 patient had moderate and the others had mild or no paravalvular leaks. The mean transvalvular gradient was 15 ± 4 mm Hg, which was higher than in patients undergoing conventional TAVR (11 ± 4 mm Hg, p = 0.02). CONCLUSIONS: THV-in-THV implantation is feasible and results in satisfactory short- and mid-term outcomes.
OBJECTIVES: This study sought to evaluate outcomes after implantation of a second transcatheter heart valve (THV-in-THV) for acute THV failure. BACKGROUND:Aortic regurgitation after transcatheter aortic valve replacement (TAVR) may be valvular due to prosthetic leaflet dysfunction or paravalvular due to poor annular sealing. METHODS:Patients undergoing aortic balloon-expandable TAVR at 3 centers were prospectively evaluated at baseline, intraprocedurally, at hospital discharge, and annually. RESULTS: Of 760 patients undergoing TAVR, 21 (2.8%) received a THV-in-THV implant due to acute, severe regurgitation. Aortic regurgitation was paravalvular in 18 patients and transvalvular in the remaining 3 patients. THV-in-THV implantation was technically successful in 19 patients (90%) and unsuccessful in 2 patients (10%), who subsequently underwent open heart surgery. Mortality at 30 days and 1 year was 14.3% and 24%, respectively. After successful THV-in-THV, mean aortic valve gradient fell from 37 ± 12 mm Hg to 13 ± 5 mm Hg (p < 0.01); aortic valve area increased from 0.64 ± 0.14 cm(2) to 1.55 ± 0.27 cm(2) (p < 0.01); and paravalvular aortic regurgitation was none in 4 patients, mild in 13 patients, and moderate in 2 patients. At 1-year follow-up, 1 patient had moderate and the others had mild or no paravalvular leaks. The mean transvalvular gradient was 15 ± 4 mm Hg, which was higher than inpatients undergoing conventional TAVR (11 ± 4 mm Hg, p = 0.02). CONCLUSIONS:THV-in-THV implantation is feasible and results in satisfactory short- and mid-term outcomes.
Authors: Kevin Phan; Dong-Fang Zhao; Nelson Wang; Ya Ruth Huo; Marco Di Eusanio; Tristan D Yan Journal: J Thorac Dis Date: 2016-01 Impact factor: 2.895
Authors: Ted E Feldman; Michael J Reardon; Vivek Rajagopal; Raj R Makkar; Tanvir K Bajwa; Neal S Kleiman; Axel Linke; Dean J Kereiakes; Ron Waksman; Vinod H Thourani; Robert C Stoler; Gregory J Mishkel; David G Rizik; Vijay S Iyer; Thomas G Gleason; Didier Tchétché; Joshua D Rovin; Maurice Buchbinder; Ian T Meredith; Matthias Götberg; Henrik Bjursten; Christopher Meduri; Michael H Salinger; Dominic J Allocco; Keith D Dawkins Journal: JAMA Date: 2018-01-02 Impact factor: 56.272
Authors: Sven Knecht; Beat Schaer; Tobias Reichlin; Florian Spies; Antonio Madaffari; Annina Vischer; Gregor Fahrni; Raban Jeger; Christoph Kaiser; Stefan Osswald; Christian Sticherling; Michael Kühne Journal: J Am Heart Assoc Date: 2020-02-22 Impact factor: 5.501