title: Transcatheter valve-in-valve implantation using Corevalve Revalving System for failed surgical aortic bioprostheses.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the performance of CoreValve Revalving System (CRS) (Medtronic, Minneapolis, Minnesota) implantation in patients with failed aortic bioprostheses.
  
  
  BACKGROUND
  Transcatheter aortic valve implantation with the CRS is an effective option in high-risk patients with severe aortic stenosis. It may be an option for patients with a failed aortic bioprosthesis, especially when the risk of a surgical redo is deemed prohibitive.
  
  
  METHODS
  CRS "valve-in-valve" implantation was performed in 25 high-risk patients with a failed bioprosthesis. Their mean age was 82.4 ± 3.2 years. New York Heart Association functional classes III and IV were present in 21 and 4 patients, respectively. The logistic EuroSCORE was 31.5 ± 14.8%, whereas the Society of Thoracic Surgeons score was 8.2 ± 4.2. Patients/prostheses were divided in type A (mainly stenotic, n = 9) and type B (mainly regurgitant, n = 16).
  
  
  RESULTS
  The implantation success rate was 100%. In group A, the peak aortic gradient significantly decreased from 77.6 ± 21.6 mm Hg to 34.6 ± 19.4 mm Hg (p = 0.001). In all but 2 patients in group B, no significant regurgitation was observed post-implantation. No patients died during the procedure. At 30 days, there were 3 deaths (12%), 2 myocardial infarctions (8%), and 3 atrioventricular blocks requiring pacemaker implantation (12%). At a mean follow-up of 6 months, there were another death (survival rate of 84%) and a pacemaker implantation (cumulative incidence of 16%). New York Heart Association functional class improved in all patients to I and II.
  
  
  CONCLUSIONS
  CRS implantation was feasible and effective regardless of the prevalent mode of failure. This finding may significantly affect the treatment of patients with a failed bioprosthesis deemed at a prohibitive risk for surgical redo.
authors: Istituto Clinico S. Ambrogio, Department of Interventional Cardiology, Milan, Italy.
authors: Francesco
authors: F
authors: Bedogni
authors: Maria Luisa
authors: ML
authors: Laudisa
authors: Samuele
authors: S
authors: Pizzocri
authors: Corrado
authors: C
authors: Tamburino
authors: Gian Paolo
authors: GP
authors: Ussia
authors: Anna Sonia
authors: AS
authors: Petronio
authors: Massimo
authors: M
authors: Napodano
authors: Angelo
authors: A
authors: Ramondo
authors: Patrizia
authors: P
authors: Presbitero
authors: Federica
authors: F
authors: Ettori
authors: Gennaro
authors: G
authors: Santoro
authors: Silvio
authors: S
authors: Klugman
authors: Federico
authors: F
authors: De Marco
authors: Nedy
authors: N
authors: Brambilla
authors: Luca
authors: L
authors: Testa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D006801:Humans; D007558:Italy; D008297:Male; D011474:Prosthesis Design; D011475:Prosthesis Failure; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome