Transcatheter Edwards Sapien XT valve in valve implantation in degenerated aortic bioprostheses via transfemoral access.
OBJECTIVE
Surgical treatment of degenerated aortic bioprostheses is associated with an increased risk of morbidity and mortality, especially in elderly patients with significant co-morbidities. Therefore, transcatheter aortic valve implantation (TAVI) performed as valve in valve technique appears as an attractive alternative treatment option. We report of a case series of seven patients with dysfunctional bioprosthetic aortic heart valves who have been treated with TAVI via transfemoral access.


RESULTS
Valve in valve implantation using the Edwards Sapien XT bioprostheses (Edwards Lifesciences LLC, Irvine, CA, USA) was performed in eight patients (3 men, 5 women, mean age 85.3 ± 6.1 years) with a high operative risk (logistic euroSCORE 27.2 ± 7.3). Six patients underwent TAVI because of high grade stenosis of the aortic bioprostheses, whereas two patients presented with high grade regurgitation. All patients suffered at least from NYHA class III dyspnea during admission. TAVI was successfully performed via transfemoral access under local anesthesia with mild analgesic medication in all cases. Mild aortic regurgitation occurred in three patients while no permanent pacemaker implantation was required. Major cardiac events or cerebrovascular events did not occur. One aneurysm spurium, with the need of one blood transfusion, occurred. All patients improved at least one NYHA class within 30 days.


CONCLUSIONS
TAVI for degenerated aortic bioprostheses, using the Edwards Sapien XT valve via transfemoral access is a feasible option for patients at high surgical risk.
Medizinische Klinik und Poliklinik I, Klinikum Grosshadern, University Hospital of Munich, Munich, Germany. martin.greif@med.uni-muenchen.de
Martin
M
Greif
Philipp
P
Lange
Helmut
H
Mair
Christoph
C
Becker
Christoph
C
Schmitz
Gerhard
G
Steinbeck
Christian
C
Kupatt
D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods; D001022:Aortic Valve Insufficiency / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization; D004417:Dyspnea / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011475:Prosthesis Failure; D012086:Reoperation; D016896:Treatment Outcome