title: When operable patients become inoperable: conversion of a surgical aortic valve replacement into transcatheter aortic valve implantation.
abstract: Transcatheter aortic valve implantation (TAVI) is a relatively new treatment option for inoperable patients with severe aortic stenosis (AS). This case describes how a planned conventional surgical aortic valve replacement (AVR) on a 73-year-old woman was successfully converted to a TAVI procedure. On extracorporal circulation it was reconized that the aortic annulus, the coronary ostiae and the proximal part of the ascending aorta were severely calcified making valve implantation impossible. Surgical closure without valve substitution was estimated to be associated with a high risk of mortality due to the imparied left ventricular function. Consequently, TAVI was performed with a CoreValve ReValving System prosthesis. The delivery of the valve prosthesis was made through the ascending part of aorta, proximal of the cannulation of aorta. Positioning of the valve prosthesis was made under visual guidance, and the prosthesis was sutured to the ascending aorta. With some manipulation of the prosthesis it was possible to suture the aorta circumferentially around the fully expanded upper part of the prosthesis. Post-procedurally the patient recovered successfully, with improved function capacity, aortic valve area and left ventricle function.
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. lenekjaerolsen@gmail.com
authors.forename: Lene Kjaer
authors.initials: LK
authors.lastname: Olsen
authors.forename: Henrik
authors.initials: H
authors.lastname: Arendrup
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
authors.forename: Lars
authors.initials: L
authors.lastname: Søndergaard
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006328:Cardiac Catheterization / Q000295:instrumentation; D005112:Extracorporeal Circulation; D005260:Female; D006324:Heart Arrest, Induced; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D011474:Prosthesis Design; D012720:Severity of Illness Index; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome