title: Transcatheter aortic valve-in-valve implantation: a selection change?
abstract: OBJECTIVE
  Aortic valve replacement for bioprosthesis dysfunction is a procedure involving considerable risk. In some cases, mortality is high and may contraindicate the procedure. Minimally invasive transcatheter aortic "valve-in-valve" implant appears to be an alternative, reducing morbidity and mortality. The objective is to evaluate aortic valve-in-valve procedure using Braile Inovare prosthesis.
  
  
  METHODS
  The Braile Inovare prosthesis, transcatheter, expandable balloon, was used in 14 cases. Average EuroSCORE was 42.9%. All patients had double aortic bioprosthesis dysfunction. Procedures were performed in a surgical hybrid environment under echocardiographic and fluoroscopic guidance. Using left minithoracotomy prostheses were implanted through the ventricular apex under high-frequency ventricular pacing. Serial clinical and echocardiographic controls were performed. Follow-up ranged 1-30 months.
  
  
  RESULTS
  Correct prosthetic deployment was obtained in all cases. There was no conversion. There was no operative mortality. The 30-day mortality was 14.3% (two cases). Ejection fraction increased significantly after the 7th postoperative day. Aortic gradient significantly reduced. The residual aortic regurgitation was not present. There were no vascular complications or complete atrioventricular block.
  
  
  CONCLUSIONS
  The transcatheter "valve-in-valve" procedure for bioprosthesis dysfunction is safe with low morbidity. This possibility may change prosthesis choice during the first aortic valve replacement, favoring bioprostheses.
authors.affiliation: Universidade Federal de São Paulo. drgaia@terra.com.br
authors.forename: Diego Felipe
authors.initials: DF
authors.lastname: Gaia
authors.forename: Aline
authors.initials: A
authors.lastname: Couto
authors.forename: João Roberto
authors.initials: JR
authors.lastname: Breda
authors.forename: Carolina Baeta Neves Duarte
authors.initials: CB
authors.lastname: Ferreira
authors.forename: Murilo Teixeira
authors.initials: MT
authors.lastname: Macedo
authors.forename: Marcus Vinicius
authors.initials: MV
authors.lastname: Gimenes
authors.forename: Enio
authors.initials: E
authors.lastname: Buffolo
authors.forename: José Honório
authors.initials: JH
authors.lastname: Palma
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000379:methods* / Q000401:mortality; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome