title: Transfemoral valve-in-valve implantation for degenerated bioprosthetic aortic valves using the new balloon-expandable Edwards Sapien 3 valve.
abstract: BACKGROUND
  Surgical aortic bioprosthetic valves deteriorate 10 to 20 years after operation. Valve-in-valve implantation with first generation transcatheter aortic valve implantation (TAVI) devices has shown to be feasible. We report a first case series with the new Edwards Sapien 3 valve for transfemoral aortic valve-in-valve implantation.
  
  
  RESULTS
  Nine patients underwent valve-in-valve-TAVI with the Edward Sapien 3 valve. Seven patients presented with severe aortic stenosis and two patients with severe aortic insufficiency of surgical aortic bioprosthesis. Procedures were performed in local anaesthesia under fluoroscopic guidance with pre-procedural 256 multislice computed tomography for procedural planning. In all patients the Edwards Sapien 3 was successfully implanted decreasing the mean echocardiographic gradient from 42 ± 22mmHg to 18 ± 7mmHg (p < 0.01). Device success according to VARC 2 criteria was achieved in 8 out of 9 patients. There was no death, coronary obstruction, use of second valve or need for post-dilation. Furthermore there were no access-site complications, no minor or major bleedings or vascular injury. Two patients required pacemaker implantation within the first 7 days after valve-in-valve TAVI. Post-procedural echocardiography demonstrated no or trace aortic regurgitation. Early safety events within 30 days according to VARC-2 definition occurred in 1 patient.
  
  
  CONCLUSIONS
  The Edwards Sapien 3 valve for treatment of failed surgical bioprostheses is feasible and is associated with no relevant post-procedural aortic regurgitation and a low risk of access site complications. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department Of Internal Medicine II, University of Ulm, Ulm, Germany.
authors.forename: Birgid
authors.initials: B
authors.lastname: Gonska
authors.affiliation: Department Of Internal Medicine II, University of Ulm, Ulm, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Seeger
authors.affiliation: Department Of Internal Medicine II, University of Ulm, Ulm, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Rodewald
authors.affiliation: Department Of Internal Medicine II, University of Ulm, Ulm, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Scharnbeck
authors.affiliation: Department Of Internal Medicine II, University of Ulm, Ulm, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rottbauer
authors.affiliation: Department Of Internal Medicine II, University of Ulm, Ulm, Germany. jochen.woehrle@uniklinik-ulm.de.
authors.forename: Jochen
authors.initials: J
authors.lastname: Wöhrle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001027:Aortography; D063126:Balloon Valvuloplasty; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods; D002406:Catheterization, Peripheral; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011677:Punctures; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic stenosis; paravalvular insufficiency; transcatheter aortic valve implantation