title: Repeat transcatheter aortic valve implantation using a latest generation balloon-expandable device for treatment of failing transcatheter heart valves.
abstract: BACKGROUND
  Paravalvular leakage (PVL) is a known complication of transcatheter aortic valve implantation (TAVI) and is associated with poor outcome. Besides balloon-post-dilatation, valve-in-valve (ViV) procedures can be taken into consideration to control this complication. Herein we present initial experience with use of the latest generation balloon-expandable Edwards Sapien 3® (S3) transcatheter heart valve (THV) for treatment of failing THVs.
  
  
  METHODS
  Between 01/2014 and 12/2014 three patients (two male, age: 71-80 y, log EUROScore I: 11.89 - 32.63) with failing THVs were refered to our institution for further treatment. THV approach with secondary implantation of an S3 was chosen after mutual agreement of the local interdisciplinary heart team at an interval of 533-1119 days from the index procedure. The performed procedures consisted of: S3 in Sapien XT, JenaValve and CoreValve.
  
  
  RESULTS
  Successful transfemoral implantation with significant reduction of PVL was achieved in all cases. No intraprocedural complications occurred regarding placement of the S3 with a postprocedural effective orifice area (EOA) of 1.5-2.5 cm(2) and pressure gradients of max/mean 14/6-36/16 mmHg. 30-day mortality was 0%. At the latest follow-up of 90-530 days, all patients are alive and well with satisfactory THV function. Regarding VARC-2 criteria one major bleeding and one TIA was reported.
  
  
  CONCLUSIONS
  In the instance of moderate or severe aortic regurgitation after TAVI, S3 ViV deployment is an excellent option to reduce residual regurgitation to none or mild. For further assertions concerning functional outcomes long-term results have to be awaited.
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistraße 52, D-20246, Hamburg, Germany. and.schaefer@uke.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schaefer
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistraße 52, D-20246, Hamburg, Germany. treede@uke.de.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Treede
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistraße 52, Hamburg, D-20246, Germany. m.seiffert@uke.de.
authors.forename: Moritz
authors.initials: M
authors.lastname: Seiffert
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistraße 52, Hamburg, D-20246, Germany. f.deuschl@uke.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Deuschl
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistraße 52, Hamburg, D-20246, Germany. n.schofer@uke.de.
authors.forename: Niklas
authors.initials: N
authors.lastname: Schofer
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistraße 52, D-20246, Hamburg, Germany. y.schneeberger@uke.de.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Schneeberger
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistraße 52, Hamburg, D-20246, Germany. s.blankenberg@uke.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistraße 52, D-20246, Hamburg, Germany. reichenspurner@uke.de.
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistraße 52, Hamburg, D-20246, Germany. u.schaefer@uke.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schaefer
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistraße 52, D-20246, Hamburg, Germany. l.conradi@uke.de.
authors.forename: Lenard
authors.initials: L
authors.lastname: Conradi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D065467:Transcatheter Aortic Valve Replacement / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome