title: Use of balloon expandable transcatheter valves for valve-in-valve implantation in patients with degenerative stentless aortic bioprostheses: Technical considerations and results.
abstract: OBJECTIVE
  Transcatheter valve-in-valve is an accepted treatment in high-risk patients with degenerative stented bioprostheses in the aortic position. Experience in treating stentless valves is, however, limited. Our aim was to determine the feasibility and single-center outcome of balloon expandable SAPIEN valve placement in degenerated stentless aortic valve bioprostheses.
  
  
  METHODS
  From February 2010 to January 2014, 10 patients with failing stentless bioprostheses underwent transcatheter aortic valve implantation using the Edwards SAPIEN transcatheter heart valve (SAPIEN, SAPIEN XT, and SAPIEN 3) at our institution. Seven patients had valve failure due to regurgitation and three to stenosis. The mean age was 73.3 ± 15.0 years. The mean logistic EuroSCORE was 31.8 ± 20.3, and the Society of Thoracic Surgeons score was 7.6 ± 5.4.
  
  
  RESULTS
  Technical success was achieved in 9 of 10 patients. One patient required immediate placement of a second valve owing to low placement of the first. Two intraoperative complications developed that needed additional procedures. One patient underwent immediate repair of a right ventricular perforation from a pacing lead, the other, reexploration for epicardial bleeding. No deaths occurred. The median length of stay was 8.5 days (range, 3-44). The mean follow-up was 8.1 months (range, 1-21). No late reoperations or reinterventions were required.
  
  
  CONCLUSIONS
  Transcatheter aortic valve implantation after previous stentless aortic valve replacement is technically demanding but a safe and feasible approach. The early results were excellent, with consistent improvement in hemodynamics. Prospective long-term follow-up in larger series is needed to evaluate this technique further.
authors.affiliation: Department of Cardiovascular Surgery and Cardiology, St Thomas' Hospital, London, United Kingdom. Electronic address: vnbapat@yahoo.com.
authors.forename: Vinayak
authors.initials: V
authors.lastname: Bapat
authors.affiliation: Department of Cardiovascular Surgery and Cardiology, St Thomas' Hospital, London, United Kingdom.
authors.forename: William
authors.initials: W
authors.lastname: Davies
authors.affiliation: Department of Cardiovascular Surgery and Cardiology, St Thomas' Hospital, London, United Kingdom.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Attia
authors.affiliation: Department of Cardiovascular Surgery and Cardiology, St Thomas' Hospital, London, United Kingdom.
authors.forename: Jane
authors.initials: J
authors.lastname: Hancock
authors.affiliation: Department of Cardiovascular Surgery and Cardiology, St Thomas' Hospital, London, United Kingdom.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Bolter
authors.affiliation: Department of Cardiovascular Surgery and Cardiology, St Thomas' Hospital, London, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Young
authors.affiliation: Department of Cardiovascular Surgery and Cardiology, St Thomas' Hospital, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Redwood
authors.affiliation: Department of Cardiovascular Surgery and Cardiology, St Thomas' Hospital, London, United Kingdom.
authors.forename: Martyn
authors.initials: M
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; 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 / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome