Valve-in-Valve Procedures in Failing Biological Xenografts Using a Novel Balloon-Expandable Device: Experience in Aortic, Mitral, and Tricuspid Positions
17 March 2015
03 June 2015
16 August 2015 (online)
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.
- 1 Milburn K, Bapat V, Thomas M. Valve-in-valve implantations: is this the new standard for degenerated bioprostheses? Review of the literature. Clin Res Cardiol 2014; 103 (6) 417-429
- 2 Beckmann A, Funkat AK, Lewandowski J , et al. Cardiac surgery in Germany during 2012: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2014; 62 (1) 5-17
- 3 D'Onofrio A, Zucchetta F, Gerosa G. Simultaneous transapical aortic and mitral valve-in-valve implantation for double prostheses dysfunction: case report and technical insights. Catheter Cardiovasc Interv 2014; 84 (3) 509-512
- 4 Ribichini F, Pesarini G, Feola M , et al. Transcatheter tricuspid valve implantation by femoral approach in trivalvular heart disease. Am J Cardiol 2013; 112 (7) 1051-1053
- 5 Greif M, Lange P, Mair H , et al. Transcatheter Edwards Sapien XT valve in valve implantation in degenerated aortic bioprostheses via transfemoral access. Clin Res Cardiol 2012; 101 (12) 993-1001
- 6 Schaefer A, Conradi L, Koschyk D , et al. Valve-in-valve procedures in failing biological xenografts with the new Edwards Sapien 3®: experiences in aortic and tricuspid position. Interact Cardiovasc Thorac Surg 2014; 19 (Suppl. 01) s102-s103
- 7 Seiffert M, Franzen O, Conradi L , et al. Series of transcatheter valve-in-valve implantations in high-risk patients with degenerated bioprostheses in aortic and mitral position. Catheter Cardiovasc Interv 2010; 76 (4) 608-615
- 8 Bijuklic K, Hansen L, Witt J, Schofer J. Successful transfemoral Edwards SAPIEN 3 valve in valve implantation in a patient with a degenerated aortic bioprosthesis associated with severe paravalvular aortic regurgitation. Clin Res Cardiol 2015; 104 (1) 92-93
- 9 Gurvitch R, Cheung A, Bedogni F, Webb JG. Coronary obstruction following transcatheter aortic valve-in-valve implantation for failed surgical bioprostheses. Catheter Cardiovasc Interv 2011; 77 (3) 439-444
- 10 Conradi L, Kloth B, Seiffert M , et al. The challenge of valve-in-valve procedures in degenerated Mitroflow bioprostheses and the advantage of using the JenaValve transcatheter heart valve. EuroIntervention 2014; 10 (8) 990-994