PMID- 22304904
OWN - NLM
STAT- MEDLINE
DCOM- 20120423
LR  - 20121115
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 93
IP  - 3
DP  - 2012 Mar
TI  - Transcatheter valve-in-valve implantation for deteriorated aortic bioprosthesis: 
      initial clinical results and follow-up in a series of high-risk patients.
PG  - 734-41
LID - 10.1016/j.athoracsur.2011.11.008 [doi]
AB  - BACKGROUND: Transcatheter aortic valve implantation (TAVI) has become a viable 
      alternative in maximum risk patients. For those patients requiring aortic valve 
      re-replacement, the "valve-in-valve" concept has been described. We report our 
      experience with transapical valve-in-valve implantation in 7 patients with 
      deteriorated aortic bioprosthesis at 1-year follow up. METHODS: Since November 
      2008, 210 patients received transapical TAVI due to severe aortic stenosis. Seven 
      patients presented with deteriorated aortic valve bioprosthesis and received 
      transapical valve-in-valve implantation. Mean age was 78.7+/-0.8 years. 
      Preoperatively, all patients were at New York Heart Association (NYHA) functional 
      class III. For risk estimation, the Society of Thoracic Surgeons (STS) and 
      European System for Cardiac Operative Risk Evaluation (ES) risk scores were used 
      and predicted high mortality (means+/-standard error of the mean: STSMortality 
      21.6+/-2.8%, ESadd 14.9+/-1.1, ESlog 52.6+/-9.0%). Mean follow-up time was 517+/-65 days 
      (range, 280 to 799 days). RESULTS: Six patients showed a severely deteriorated 
      bioprosthesis in terms of a stenotic valve (aortic valve area: 0.64+/-0.04 cm2, 
      maximum/mean developed transvalvular pressure gradient: dPmax 63.3+/-10.9 mm Hg, 
      dPmean 40.4+/-5.6 mm Hg). One patient's deteriorated prosthesis was highly 
      insufficient. Procedural success rate was 100%, mean procedure time was 46.7+/-12.3 
      minutes. Echocardiography revealed excellent hemodynamics of implanted prosthesis 
      (dPmax 31.1+/-5.5 mm Hg; dPmean 19.4+/-4.3 mm Hg). Overall, postoperative course was 
      uneventful. No patient died during follow-up, which ranged up to 26 months. All 
      patients, except 1, remained in NYHA class I or II. CONCLUSIONS: Our results 
      demonstrate feasibility and safety of the transapical valve-in-valve approach 
      with excellent hemodynamic and clinical results. Decision making in a 
      multidisciplinary setting is mandatory. Further studies with more patients and 
      longer follow-up are needed to identify candidates benefiting from transapical 
      transcatheter valve-in-valve implantation.
CI  - Copyright (c) 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Wilbring, Manuel
AU  - Wilbring M
AD  - Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany. 
      manuel.wilbring@gmail.com
FAU - Sill, Bjoern
AU  - Sill B
FAU - Tugtekin, Sems Malte
AU  - Tugtekin SM
FAU - Alexiou, Konstantin
AU  - Alexiou K
FAU - Simonis, Gregor
AU  - Simonis G
FAU - Matschke, Klaus
AU  - Matschke K
FAU - Kappert, Utz
AU  - Kappert U
LA  - eng
PT  - Journal Article
DEP - 20120203
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve Stenosis/*surgery
MH  - *Bioprosthesis
MH  - *Cardiac Catheterization
MH  - Female
MH  - Follow-Up Studies
MH  - *Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/*methods
MH  - Humans
MH  - Male
MH  - *Prosthesis Failure
MH  - Retrospective Studies
MH  - Risk Factors
EDAT- 2012/02/07 06:00
MHDA- 2012/04/24 06:00
CRDT- 2012/02/07 06:00
PHST- 2011/09/13 00:00 [received]
PHST- 2011/11/03 00:00 [revised]
PHST- 2011/11/03 00:00 [accepted]
PHST- 2012/02/07 06:00 [entrez]
PHST- 2012/02/07 06:00 [pubmed]
PHST- 2012/04/24 06:00 [medline]
AID - S0003-4975(11)02631-2 [pii]
AID - 10.1016/j.athoracsur.2011.11.008 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2012 Mar;93(3):734-41. doi: 10.1016/j.athoracsur.2011.11.008. 
      Epub 2012 Feb 3.