Valve-in-Valve Procedures in Failing Biological Xenografts Using a Novel Balloon-Expandable Device: Experience in Aortic, Mitral, and Tricuspid Positions.
Background Valve-in-valve (ViV) procedures for degenerated bioprostheses are an alternative for the standard of care in an aging population. Several reports showed that the Edwards Sapien XT (Edwards Lifesciences Co., Irvine, California, United States) transcatheter heart valve (THV) can be used in aortic, mitral, and tricuspid position for ViV procedures. No published case series for different valve positions exist regarding suitability of the new Edwards Sapien 3 (Edwards Lifesciences Co.) THV for this purpose. Especially, the increased stent height compared with the XT and the newly added polyethylene terephthalate cuff is of potential concern in ViV interventions. Herein, we report six cases of ViV procedures with the Edwards Sapien 3 THV with a focus on technical considerations. Methods and Results Between October 2013 and November 2014, six ViV procedures with the Edwards Sapien 3 THV were performed. Four implants were done in aortic, one in mitral, and one in tricuspid position. All procedures were performed successfully without any complications. Fluoroscopy and echocardiography confirmed an adequate position and function without any paravalvular or transvalvular leakage or elevated transvalvular gradients in any case. Conclusion Preliminary experience suggests, ViV procedures with the Edwards Sapien 3 THV are safe and reliable. The outer polyethylene terephthalate cuff, for enhanced paravalvular sealing, led to a good outcome, concerning PVL in ViV procedures without resulting in elevated transvalvular gradients. This was even the case in a mildly undersized THV when compared with the internal diameter of the surgical bioprosthesis. The central radiopaque positioning marker and the fine adjustment wheel allow for accurate positioning within degenerated bioprostheses. The increased stent height, compared with the Sapien XT, led to no complications, especially in mitral position. In bioprostheses without any fluoroscopic landmarks, a balloon valvuloplasty may be necessary to identify the appropriate deployment position.
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Andreas
A
Schaefer
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Lenard
L
Conradi
Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
Moritz
M
Seiffert
Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
Edith
E
Lubos
Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
Stefan
S
Blankenberg
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Hermann
H
Reichenspurner
Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
Ulrich
U
Schaefer
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Hendrik
H
Treede
D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D063126:Balloon Valvuloplasty / Q000009:adverse effects; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D064593:Heterografts; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D061330:Multidetector Computed Tomography; D011093:Polyethylene Terephthalates; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019233:Retreatment; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*
D011093:Polyethylene Terephthalates