title: Performance of valve-in-valve for severe para-prosthetic leaks due to inadequate transcatheter aortic valve implantation.
abstract: OBJECTIVE
  This study reports on mid-term safety and performance of valve-in-valve implantation as rescue strategy to overcome acute PPL after TAVI.
  
  
  BACKGROUND
  Moderate to severe para-prosthetic leaks (PPL) after transcatheter aortic valve implantation (TAVI) have been described with both self-expandable and balloon-expandable device.
  
  
  METHODS
  We analyzed data regarding patients who underwent valve-in-valve implantation, enrolled in the ongoing single-center prospective registry of TAVI, the Padova University REVALVing experience Registry. All procedures were performed by a totally percutaneous approach, using the self-expanding Medtronic CoreValve (Medtronic, Minneapolis, MN).
  
  
  RESULTS
  Out of 87 patients who underwent TAVI, six received valve-in-valve implantation because of persisting severe PPL, due to prosthesis malposition. In all patients, the second device was successfully deployed, with a significant reduction in aortic regurgitation: PPL was no longer appreciable in two of six patients, and it decreased from severe to mild or trivial in four patients. Four patients developed atrio-ventricular block requiring pace-maker implantation. At follow-up (6-24 months) two patients died, whereas no prosthesis-related death occurred. Transprosthesis pressure gradient, effective orifice area, and aortic regurgitation did not change at serial echocardiograms throughout the follow-up.
  
  
  CONCLUSIONS
  Valve-in-valve implantation using self-expandable bioprosthesis seems safe and highly effective to overcome severe PPL due to prosthesis malposition early after TAVI. Moreover, the implantation of two valves does not affect the performance of prosthesis at follow-up.
authors: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy. massimo.napodano@gmail.com
authors: Massimo
authors: M
authors: Napodano
authors: Valeria
authors: V
authors: Gasparetto
authors: Giuseppe
authors: G
authors: Tarantini
authors: Chiara
authors: C
authors: Fraccaro
authors: Ermela
authors: E
authors: Yzeiraj
authors: Gino
authors: G
authors: Gerosa
authors: Giambattista
authors: G
authors: Isabella
authors: Sabino
authors: S
authors: Iliceto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; 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; D006439:Hemodynamics; D006801:Humans; D007558:Italy; D008297:Male; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D019233:Retreatment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome