title: Transfemoral aortic valve-in-valve implantation with the CoreValve Evolut for small degenerated stented bioprosthesis.
abstract: Transcatheter aortic valve-in-valve implantation represents one interesting therapeutic option for high-risk surgical patients with degenerated bioprostheses. The procedure is less invasive and can be performed without thoracotomy and general anesthesia, if the femoral approach is used. Until recently, failing small bioprostheses could only be treated percutaneously by underexpanding the CoreValve (Medtronic, Inc) or Edwards Sapien valve (Edwards Lifesciences). Underexpansion of these valves might compromise the hemodynamic performance and potentially limit its durability. Herein, we report our initial experience with the 23 mm CoreValve Evolut in 4 patients with degenerated 21 mm Mitroflow valves. The CoreValve prosthesis was successfully implanted in all 4 patients, with no major complications and no mortality at 3-month follow-up exam. However, 2 of the 4 patients developed mildly elevated transvalvular gradients. Therefore, despite our promising results, caution is necessary when considering patients with small degenerated bioprostheses for a valve-in-valve procedure.
authors.affiliation: Heart and Diabetes Center North Rhine-Westphalia, Department of Cardiology, Georgstr. 11, D-32545 Bad Oeynhausen, Germany. akleemeyer@hdz-nrw.de.
authors.forename: Smita R
authors.initials: SR
authors.lastname: Jategaonkar
authors.forename: Werner
authors.initials: W
authors.lastname: Scholtz
authors.forename: Dieter
authors.initials: D
authors.lastname: Horstkotte
authors.forename: Jan
authors.initials: J
authors.lastname: Gummert
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Ensminger
authors.forename: Jochen
authors.initials: J
authors.lastname: Börgermann
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D000082882:Bicuspid Aortic Valve Disease; D001705:Bioprosthesis; D005263:Femoral Artery; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000628:therapy*; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome