title: First-in-human valve-in-valve implantation of a 20 mm balloon expandable transcatheter heart valve.
abstract: An 86-year-old lady with recurrent admissions for heart failure due to a severely regurgitant aortic bioprosthesis (SJM Epic 19 mm) was not a candidate for re-operation due to age and frailty. Her small ilio-femoral arteries precluded a transfemoral transcatheter valve-in-valve (VIV) approach. The small internal diameter of her bioprosthesis (16 mm) forbids the implantation of the smallest available transapical transcatheter heart valve (THV). We, therefore, decided to perform a first-in-human transapical aortic VIV implantation using a 20 mm balloon expandable THV and a transfemoral delivery system. The procedure was successfully performed under general anesthesia, without any contrast dye and under fluoroscopy as well as transesophageal echocardiography guidance. The post-procedural transvalvular gradient was 15 mm Hg (pre-procedural 14 mm Hg). At 30-day follow-up, the lady was living independently at home without shortness of breath during her daily activities. If redo-surgery for prosthetic regurgitation is not an option, VIV implantation in very small surgical bioprosthesis is feasible and leads to acceptable hemodynamics and clinical improvement.
authors: St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Ronald K
authors: RK
authors: Binder
authors: David
authors: D
authors: Wood
authors: John G
authors: JG
authors: Webb
authors: Anson
authors: A
authors: Cheung
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D063126:Balloon Valvuloplasty; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation*; D017548:Echocardiography, Transesophageal; D005260:Female; D005471:Fluoroscopy; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015641:Radiography, Interventional / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods