title: Transcatheter aortic valve implantation for failing surgical aortic bioprosthetic valve: from concept to clinical application and evaluation (part 2).
abstract: OBJECTIVE
  This study sought to review the acute procedural outcomes of patients who underwent transcatheter aortic valve (TAV)-in-surgical aortic valve (SAV) implantation at the German Heart Center, Munich, and to summarize the existing literature on TAV-in-SAV implantation (n = 47).
  
  
  BACKGROUND
  There are several case reports and small case series describing transcatheter aortic valve implantation for a failing surgical aortic valve bioprosthesis (TAV-in-SAV implantation).
  
  
  METHODS
  From January 2007 to March 2011, 20 out of 556 patients underwent a TAV-in-SAV implantation at the German Heart Center Munich. Baseline characteristics and clinical outcome data were prospectively entered into a dedicated database.
  
  
  RESULTS
  The mean patient age was 75 ± 13 years, and the mean logistic European System for Cardiac Operative Risk Evaluation and Society of Thoracic Surgeons' Risk Model scores were 27 ± 13% and 7 ± 4%, respectively. Of the 20 patients, 14 had stented and 6 had stentless surgical bioprostheses. Most cases (12 of 20) were performed via the transapical route using a 23-mm Edwards Sapien prosthesis (Edwards Lifesciences, Irvine, California). Successful implantation of a TAV in a SAV with the patient leaving the catheterization laboratory alive was achieved in 18 of 20 patients. The mean transaortic valve gradient was 20.0 ± 7.5 mm Hg. None-to-trivial, mild, and mild-to-moderate paravalvular aortic regurgitation was observed in 10, 6, and 2 patients, respectively. We experienced 1 intraprocedural death following pre-implant balloon aortic valvuloplasty ("stone heart") and 2 further in-hospital deaths due to myocardial infarction.
  
  
  CONCLUSIONS
  TAV-in-SAV implantation is a safe and feasible treatment for high-risk patients with failing aortic bioprosthetic valves and should be considered as part of the armamentarium in the treatment of aortic bioprosthetic valve failure.
authors.affiliation: Department of Cardiovascular Surgery, German Heart Center, Munich, Germany. nicolopiazza@mac.com
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
authors.forename: Sabine
authors.initials: S
authors.lastname: Bleiziffer
authors.forename: Gernot
authors.initials: G
authors.lastname: Brockmann
authors.forename: Ruge
authors.initials: R
authors.lastname: Hendrick
authors.forename: Marcus-André
authors.initials: MA
authors.lastname: Deutsch
authors.forename: Anke
authors.initials: A
authors.lastname: Opitz
authors.forename: Domenico
authors.initials: D
authors.lastname: Mazzitelli
authors.forename: Peter
authors.initials: P
authors.lastname: Tassani-Prell
authors.forename: Christian
authors.initials: C
authors.lastname: Schreiber
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome