What if Valve-in-Valve TAVR fails? Is surgical re-replacement still an option in high-risk patients? A case report.

Luca De Donno; Alan Galligani; Francesco  Maestri; Florida Gripshi; Claudia Pattuzzi; Matteo Scarpanti; Elena Adelina Gabor; Arianna Manca; Francesco  Nicolini

doi:10.23750/abm.v93iS1.11705

What if Valve-in-Valve TAVR fails? Is surgical re-replacement still an option in high-risk patients? A case report.

Authors

Luca De Donno a:1:{s:5:"en_US";s:55:"Departement of Cardiac Suurgery, Parma General Hospital";}
Alan Galligani Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital “Azienda Ospedaliera-Universiteria” of Parma, Parma, Italy.
Francesco Maestri Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital “Azienda Ospedaliera-Universiteria” of Parma, Parma, Italy.
Florida Gripshi Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital “Azienda Ospedaliera-Universiteria” of Parma, University of Parma, Parma, Italy
Claudia Pattuzzi Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital “Azienda Ospedaliera-Universiteria” of Parma, University of Parma, Parma, Italy
Matteo Scarpanti Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital “Azienda Ospedaliera-Universiteria” of Parma, University of Parma, Parma, Italy
Elena Adelina Gabor Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital “Azienda Ospedaliera-Universiteria” of Parma, University of Parma, Parma, Italy
Arianna Manca Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital “Azienda Ospedaliera-Universiteria” of Parma, University of Parma, Parma, Italy
Francesco Nicolini Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital “Azienda Ospedaliera-Universiteria” of Parma, University of Parma, Parma, Italy

DOI: https://doi.org/10.23750/abm.v93iS1.11705

Keywords:

Redo aortic surgery, transcatheter aortic valve replacement, surgical aortic valve replacement, valve dislocation.

Abstract

Redo surgical aortic valve replacement has been the gold standard for the treatment of degenerated bioprostheses; however it carries an inherent risk associated with a reoperative open heart surgery. Valve-in-Valve transcatheter aortic valve implantation (ViV-TAVI) has emerged as an alternative approach. Few articles in literature review transcatheter aortic valve replacement’s failure rates, complications (i.e., valve dislocation, paravalvular leaks) and their surgical management. The rate of reoperations after a percutaneous approach is expected to increase, with the currently rising number of transcatheter procedures worldwide even in patients with a longer life expectancy. Valve dislocation is a rare but serious complication that can severely impact on the outcome of patients. Paravalvular leaks and structural valve degeneration are the most common causes of surgical re-intervention. We present the case of a complex patient with previous surgical aortic valve and ascending aorta replacement who underwent a transfemoral valve-in-valve TAVI for bioprosthesis degeneration, complicated by valve dislocation requiring surgical reoperation.

References

Johnston DR, Soltesz EG, Vakil N, et al. Long-term durability of bioprosthetic aortic valves: implications from 12,569 implants. Ann Thorac Surg 2015;99(4):1239-47. doi: 10.1016/j.athoracsur.2014.10.070. Epub 2015 Feb 4. PMID: 25662439; PMCID: PMC5132179..

Foroutan F, Guyatt GH, O’Brien K, et al. Prognosis after surgical replacement with a bioprosthetic aortic valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies. BMJ 2016;354:i5065. doi: 10.1136/bmj.i5065. PMID: 27683072; PMCID: PMC5040922..

Mylotte D, Andalib A, Thériault-Lauzier P, et al. Transcatheter heart valve failure: a systematic review. Eur Heart J 2015;36(21):1306-27. doi: 10.1093/eurheartj/ehu388. Epub 2014 Sep 28. PMID: 25265974.

Amat-Santos IJ, Cortés C, Varela-Falcón LH. Delayed left anterior mitral leaflet perforation and infective endocarditis after transapical aortic valve implantation-Case report and systematic review. Catheter Cardiovasc Interv 2017;89(5):951-954. doi: 10.1002/ccd.26410. Epub 2016 Jan 17. PMID: 26775197.

Tiroch K, Schleiting H, Karpettas N, et al. How should I treat dislocation of a TAVI SAPIEN prosthesis into the left ventricle? EuroIntervention 2015;10(11):1370-2. doi: 10.4244/EIJY14M09_04. PMID: 25244641.

Wang N, Lal S. Post-dilation in transcatheter aortic valve replacement: A systematic review and meta-analysis. J Interven Cardiol 2017;30:204–211.

Nietlispach F, Maisano F. Balloon post-dilation after transcatheter aortic valve replacement: a solution worth trying in patients with residual aortic insufficiency. JACC Cardiovasc Interv 2014;7(7):790-1. doi: 10.1016/j.jcin.2014.04.004. PMID: 25060023.

Chiam PT, Ewe SH, Soon JL, et al. Percutaneous transcatheter aortic valve implantation for degenerated surgical bioprostheses: the first case series in Asia with one-year follow-up. Singapore Med J 2016;57(7):401-5. doi: 10.11622/smedj.2016097. Epub 2016 May 19. PMID: 27193081; PMCID: PMC4958718.

Kapadia SR, Leon MB, Makkar RR, et al. 5-Year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): A randomized controlled trial. Lancet 2015; 385: 2485 – 2491.

Mack MJ, Leon MB, Smith CR, et al. 5-Year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): A randomized controlled trial. Lancet 2015; 385: 2477 – 2484.

Barbanti M, Petronio AS, Ettori F, et al. 5-Year Outcomes After Transcatheter Aortic Valve Implantation With CoreValve Prosthesis. JACC Cardiovasc Interv 2015;8(8):1084-1091. doi: 10.1016/j.jcin.2015.03.024. Epub 2015 Jun 24. PMID: 26117458.

Ando T, Takagi H; ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. Percutaneous Closure of Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation: A Systematic Review. Clin Cardiol 2016;39(10):608-614. doi: 10.1002/clc.22569. Epub 2016 Jul 11. PMID: 27396630; PMCID: PMC6490807.

Rallidis LS, Moyssakis IE, Ikonomidis I, Nihoyannopoulos P. Natural history of early aortic paraprosthetic regurgitation: a five-year follow-up. Am Heart J 1999;138:351–7.

Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012; 366:1686–95

Hahn RT, Pibarot P, Webb J, et al. Outcomes with post-dilation following transcatheter aortic valve replacement in the PARTNER (Placement of Aortic Transcatheter Valve) I trial. J Am Coll Cardiol Intv 2014;7:781–9.

Ussia GP, Barbanti M, Sarkar K, et al. Transcatheter aortic bioprosthesis dislocation: technical aspects and midterm follow-up. EuroIntervention 2012;7(11):1285-92. doi: 10.4244/EIJV7I11A203. PMID: 22433191.

Jawitz OK, Gulack BC, Grau-Sepulveda MV, et al. Reoperation After Transcatheter Aortic Valve Replacement: An Analysis of the Society of Thoracic Surgeons Database. JACC Cardiovasc Interv 2020;13(13):1515-1525. doi: 10.1016/j.jcin.2020.04.029. Epub 2020 Jun 10. PMID: 32535005; PMCID: PMC7354233.