PMID- 25661576
OWN - NLM
STAT- MEDLINE
DCOM- 20150730
LR  - 20201218
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 99
IP  - 5
DP  - 2015 May
TI  - Single Institution Experience With Transcatheter Valve-in-Valve Implantation 
      Emphasizing Strategies for Coronary Protection.
PG  - 1532-8
LID - S0003-4975(14)02214-0 [pii]
LID - 10.1016/j.athoracsur.2014.11.047 [doi]
AB  - BACKGROUND: Transcatheter valve-in-valve (VIV) implantation evolved as a 
      therapeutic alternative, despite an increased risk of coronary obstruction in 
      comparison with a regular transcatheter aortic valve implantation (TAVI). We 
      report a comprehensive single-institution experience emphasizing strategies to 
      reduce the risk of myocardial ischemia. METHODS: Since 2009, 639 patients 
      underwent a TAVI procedure in our institution. All patients are prospectively 
      collected into an institutional registry. In total 31 patients underwent a VIV 
      procedure at our institution (age 77.8 +/- 6.3 years; The Society or Thoracic 
      Surgeons predicted risk of mortality 20.9% +/- 8.8%; New York Heart Association 
      (NYHA) 3.0 +/- 0.6). Degenerated bioprostheses included 24 Mitroflow, 6 Edwards 
      Perimount, and Cryo-Valve O' Brien with label sizes from 21 to 27 mm. The type of 
      failure was mostly regurgitation with or without concomitant stenosis (78%). 
      RESULTS: Patients were provided with 5 Medtronic CoreValves, 15 Edwards SapienXT, 
      1 Edwards Sapien 3, 7 Medtronic Engager, and 3 Symetis Acurate TA valves. The 
      procedural success rate was 88%. The left main stem was occluded in 1 patient 
      (Sapien XT 26 in a Mitroflow 25 mm) who underwent emergent revascularization. Two 
      patients suffering from a degenerated Mitroflow prosthesis needed a second valve 
      (Sapien XT). Two patients with a degenerated Mitroflow prosthesis treated with a 
      Sapien XT developed postprocedural myocardial ischemia and deceased on 
      postoperative days 1 and 2, accounting to an overall incidence of coronary 
      insufficiency associated to the VIV procedure of 10%. With the introduction of 
      valves allowing commissural alignment (Acurate TA) and leaflet capturing as well 
      (Engager) no further coronary insufficiency occurred. The mean gradient decreased 
      significantly from 39.3 +/- 14.0 to 16.1 +/- 7.2 mm Hg (p = 0.002). Post-procedural 
      regurgitation was classified as trace in 7 patients (23%) and moderate in 4 
      patients (13%). The 30-day survival was 77% with a significantly improved NYHA 
      class of 1.79 +/- 0.58 (p = 0.001). CONCLUSIONS: Jeopardizing coronary blood flow 
      is likely in stenotic and calcified bioprostheses, particularly in tubelike 
      aortic sinuses. Planning, imaging, and the use of valves allowing commissural 
      alignment as well as leaflet capturing seem to reduce the risk. Further studies 
      are necessary to support this hypothesis.
CI  - Copyright (c) 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Camboni, Daniele
AU  - Camboni D
AD  - Department of Cardiothoracic Surgery, University Medical Center Regensburg, 
      Regensburg, Germany. Electronic address: daniele.camboni@ukr.de.
FAU - Holzamer, Andreas
AU  - Holzamer A
AD  - Department of Cardiothoracic Surgery, University Medical Center Regensburg, 
      Regensburg, Germany.
FAU - Florchinger, Bernhard
AU  - Florchinger B
AD  - Department of Cardiothoracic Surgery, University Medical Center Regensburg, 
      Regensburg, Germany.
FAU - Debl, Kurt
AU  - Debl K
AD  - Department of Internal Medicine II (Cardiology), University Medical Center 
      Regensburg, Regensburg, Germany.
FAU - Endeman, Dierk
AU  - Endeman D
AD  - Department of Internal Medicine II (Cardiology), University Medical Center 
      Regensburg, Regensburg, Germany.
FAU - Zausig, York
AU  - Zausig Y
AD  - Department of Anesthesiology, University Medical Center Regensburg, Regensburg, 
      Germany.
FAU - Maier, Lars S
AU  - Maier LS
AD  - Department of Internal Medicine II (Cardiology), University Medical Center 
      Regensburg, Regensburg, Germany.
FAU - Schmid, Christof
AU  - Schmid C
AD  - Department of Cardiothoracic Surgery, University Medical Center Regensburg, 
      Regensburg, Germany.
FAU - Hilker, Michael
AU  - Hilker M
AD  - Department of Cardiothoracic Surgery, University Medical Center Regensburg, 
      Regensburg, Germany.
LA  - eng
PT  - Journal Article
DEP - 20150207
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/surgery
MH  - Bicuspid Aortic Valve Disease
MH  - *Bioprosthesis
MH  - Cardiac Catheterization
MH  - Coronary Occlusion/etiology/*prevention & control
MH  - Female
MH  - Heart Defects, Congenital/*surgery
MH  - Heart Valve Diseases/*surgery
MH  - *Heart Valve Prosthesis
MH  - Humans
MH  - Male
MH  - Retrospective Studies
MH  - Transcatheter Aortic Valve Replacement/adverse effects/*methods
MH  - Treatment Outcome
EDAT- 2015/02/11 06:00
MHDA- 2015/08/01 06:00
CRDT- 2015/02/10 06:00
PHST- 2014/07/20 00:00 [received]
PHST- 2014/11/14 00:00 [revised]
PHST- 2014/11/26 00:00 [accepted]
PHST- 2015/02/10 06:00 [entrez]
PHST- 2015/02/11 06:00 [pubmed]
PHST- 2015/08/01 06:00 [medline]
AID - S0003-4975(14)02214-0 [pii]
AID - 10.1016/j.athoracsur.2014.11.047 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2015 May;99(5):1532-8. doi: 10.1016/j.athoracsur.2014.11.047. 
      Epub 2015 Feb 7.