title: Valve-in-valve implantation of Medtronic CoreValve prosthesis in patients with failing bioprosthetic aortic valves.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) using the Medtronic CoreValve (MCV) system might represent an alternative to conventional redo surgery in older high-risk patients with a failing aortic valve bioprosthesis.
  
  
  RESULTS
  Symptomatic patients with failing aortic valve bioprosthesis, aged ≥65 years with a logistic EuroSCORE ≥10 % were considered for treatment. Local anesthesia was used to retrogradely implant the MCV system into the failing bioprosthetic valve. Clinical events were recorded and a transthoracic echocardiography was performed to evaluate the impact of MCV on hemodynamics after transcatheter aortic valve implantation. A total of 27 patients (aged 74.8±8 years, logistic EuroSCORE of 31±17%) were treated. In those with AS and AS and AR (n=25), the mean gradient declined from 42±16 mm Hg before to 18±8 mm Hg after MCV implantation (P<0.001), in those with AR the level declined by 2. There was no intraprocedural death and no procedural myocardial infarction. On the basis of the definitions of the Valvular Academic Research Consortium, the rate of major stroke was 7.4 %, of life-threatening bleeding 7.4%, of kidney failure stage III 7.4%, and of major access site complication 11.1 %, respectively. Within 30 days after the procedure, 2 patients died; 1 from stroke and 1 from cardiac failure (30-day mortality: 7.4%).
  
  
  CONCLUSIONS
  These results suggest that transfemoral mcv implantation into a wide range of degenerated aortic bioprosthetic valves - irrespective of the failure mode - is feasible, safe, and improves hemodynamics in older patients with higher risk for conventional aortic valve redo surgery.
authors.affiliation: Department of Cardiology, University of Leipzig-Heart Center, Leipzig, Germany. linkea@medizin.uni-leipzig.de
authors.forename: Axel
authors.initials: A
authors.lastname: Linke
authors.forename: Felix
authors.initials: F
authors.lastname: Woitek
authors.forename: Marc W
authors.initials: MW
authors.lastname: Merx
authors.forename: Conrad
authors.initials: C
authors.lastname: Schiefer
authors.forename: Sven
authors.initials: S
authors.lastname: Möbius-Winkler
authors.forename: David
authors.initials: D
authors.lastname: Holzhey
authors.forename: Ardawan
authors.initials: A
authors.lastname: Rastan
authors.forename: Jörg
authors.initials: J
authors.lastname: Ender
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery; D006333:Heart Failure / Q000209:etiology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D006439:Hemodynamics; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D011474:Prosthesis Design; D011475:Prosthesis Failure; D051437:Renal Insufficiency / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography