Valve-in-Valve-in-Valve transcatheter aortic valve implantation; to treat a degenerated surgical bioprosthesis in a subaortic position
Texas Heart Institute Journal , Volume 40 - Issue 3 p. 323- 325
Transcatheter aortic valve implantation for aortic stenosis has evolved as an alternative treatment for patients who are at high or excessive surgical risk. We report the case of an 84-year-old man with a degenerated surgically implanted valve in a subaortic position (9 mm below the native annulus) who underwent "valve-in-valve" transcatheter aortic valve implantation with use of a Medtronic CoreValve system. We planned to deploy the Core-Valve at a conventional depth in the left ventricular outflow tract; we realized that this might result in paravalvular regurgitation, but it would also afford a "deep" landing site for a second valve, if necessary. Ultimately, we implanted a second CoreValve deep in the left ventricular outflow tract to seal a paravalvular leak. The frame of the first valve-positioned at the conventional depth-enabled secure anchoring of the second valve in a deeper position, which in turn effected successful treatment of the failing subaortic surgical prosthesis without paravalvular regurgitation.
|Aortic valve insufficiency/surgery, Bioprosthesis, Heart valve prosthesis implantation/ instrumentation/methods, Intention-to-treat analysis, Reoperation/methods, Risk assessment, Treatment outcome|
|Texas Heart Institute Journal|
|Organisation||Erasmus MC: University Medical Center Rotterdam|
Nuis, R-J.M, Benitez, J, Nader, C.A, Perez, S, de Marchena, E, & Dager, A.E. (2013). Valve-in-Valve-in-Valve transcatheter aortic valve implantation; to treat a degenerated surgical bioprosthesis in a subaortic position. Texas Heart Institute Journal, 40(3), 323–325. Retrieved from http://hdl.handle.net/1765/91999