title: Transcatheter aortic valve-in-valve implantation of a CoreValve in a degenerated aortic bioprosthesis.
abstract: In recent years percutaneous aortic valve implantation has emerged as an alternative therapy to treat patients with symptomatic aortic stenosis considered to be high-risk surgical candidates. We report our experience of a percutaneous retrograde CoreValve implantation in a 77-year-old female with aortic bioprosthesis structural degeneration. The patient underwent aortic valve replacement for aortic stenosis in 1999 with the implantation of a 23 mm Carpentier-Edwards; her last echocardiography showed a severe bioprosthesis stenosis. After evaluation by cardiac surgeons and cardiologist, considering the high risk re-do surgical procedure (Logistic Euroscore 30%) and severe comorbidities (severe pulmonary hypertension, hepatocellular carcinoma and severe osteoporosis), a percutaneous aortic valve-in-valve replacement was preferred. A successful percutaneous 26 mm CoreValve prosthesis implantation was performed with the patient awake with local anesthesia and mild sedation. The patient was discharged after 10 days of hospitalization and she is in NYHA functional class I at follow-up. Our experience, characterized by a multidisciplinary approach, necessary to offer the safest conditions and care for patients, demonstrates the feasibility of a new, promising indication for the use of a transcatheter valve implantation: percutaneous treatment of a degenerated aortic bioprosthesis.
authors.affiliation: A De Gasperis Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Milan, Italy. giuseppe.bruschi@fastwebnet.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bruschi
authors.forename: Federico
authors.initials: F
authors.lastname: DeMarco
authors.forename: Jacopo
authors.initials: J
authors.lastname: Oreglia
authors.forename: Paola
authors.initials: P
authors.lastname: Colombo
authors.forename: Pasquale
authors.initials: P
authors.lastname: Fratto
authors.forename: Francesca
authors.initials: F
authors.lastname: Lullo
authors.forename: Roberto
authors.initials: R
authors.lastname: Paino
authors.forename: Luigi
authors.initials: L
authors.lastname: Martinelli
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugmann
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015641:Radiography, Interventional; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography