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DOI: 10.1055/s-0039-1678875
How to Prepare an Easy Device Landing Zone for Transcatheter Aortic Valve Implantation in Pure Aortic Regurgitation—Proof of Concept
Publication History
Publication Date:
28 January 2019 (online)
Objectives: Transcatheter aortic valve implantation (TAVI) in pure aortic regurgitation (AR) is challenging because of the subsequent difficulty in anchoring the transcatheter valve in a noncalcified device landing zone (DLZ). Prestenting can help prepare a stable DLZ for TAVI in pure AR, prevent valve migration, and improve device success. In an initial case series, we report the novel technique of uncovered stent implantation into a noncalcified aortic valve as a prestenting strategy to prepare a neo DLZ for TAVI in pure AR.
Methods: Between July 2017 and May 2018, five consecutive patients with pure AR of their native aortic valve and high risk for surgical aortic valve replacement underwent a TAVI procedure (Table 1). To prevent valve migration, an uncovered stent (sinus XL, 40 mm length, OptiMed-Medizinische-Instrumente-GmbH, Ettlingen, Germany) was implanted into the DLZ just before a SAPIEN-3 valve (Edwards Lifesciences, Irvine, California, United States) was deployed in a standard manner. In patients without permanent mechanical circulatory support (n = 2), TAVI was performed under a short duration of cardiopulmonary bypass for safety reasons using percutaneous peripheral cannulation.
Results: According to Valve Academic Research Consortium-II (VARC-II) criteria, device success was achieved in all patients (100%). Postprocedural aortic valve regurgitation was absent in three patients (60%) and trace in two patients (40%). There was no in-hospital mortality. Postprocedural computed tomography scans confirmed a stable position of the SAPIEN-3 valve and the stent inside the DLZ. Beside acute renal failure in one patient (20%), there were no further procedure-related VARC-II events.
Conclusion: TAVI has been shown to be effective in eliminating pure AR but was associated with a high necessity of implantation of a second valve. In our initial case series of five patients, prestenting prepared an easy DLZ for TAVI in pure AR and prevented valve migration. We consider this prestenting technique a useful novel strategy that may be applicable also in patients without mechanical circulatory support, at least as long as specific TAVR devices for pure AR are lacking.
Pat. |
Gender |
Age (y) |
TAVI indication |
EuroSCORE II (%) |
Mean annulus diameter (mm) |
Sinus XL stent diameter (mm) |
TAVI strategy |
Device success |
Status after TAVI |
---|---|---|---|---|---|---|---|---|---|
1 |
Male |
71.8 |
s/p LVAD |
62.4 |
28.0 |
32 |
TF SAPIEN-3 29 mm |
Yes |
Death after 105 d (right heart failure) |
2 |
Male |
77.6 |
s/p LVAD |
10.4 |
25.8 |
30 |
TF SAPIEN-3 29 mm |
Yes |
Alive after 211 d |
3 |
Male |
69.9 |
s/p LVAD |
39.6 |
25.1 |
30 |
TF SAPIEN-3 29 mm |
Yes |
Death after 13 d (septic MOF) |
4 |
Male |
75.6 |
s/p aortic dissection |
2.4 |
27.3 |
32 |
TF SAPIEN-3 29 mm |
Yes |
Alive after 120 d |
5 |
Female |
67.7 |
Frailty, immobility |
6.7 |
24.5 |
30 |
TA SAPIEN-3 29 mm |
Yes |
Alive after 106 d |
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No conflict of interest has been declared by the author(s).