Author + information
- Pablo Codner,
- Abid Assali,
- Hana Vaknin-Assa,
- Katia Orvin,
- Gabriel Greenberg,
- Yaron Shapira,
- Alexander Sagie and
- Ran Kornowski
Trans-catheter heart valve implantation is a therapeutic option for the treatment of patients with bioprosthetic valve failure. We describe our experience using this technique in the treatment of degenerated mitral, aortic and tricuspid bioprosthetic-valves.
33 patients underwent a valve-in-valve procedure, with the implantation of 34 percutaneous implantable valves. Both, the Edwards-Sapien and the CoreValve devices were used. Outcomes were evaluated using the Valve Academic Research Consortium 2 criteria.
Valve-in-Valve in the aortic position: mean age of patients was 81.4 ± 5.9 years. NYHA III/IV before the procedure was present in 95.6% of patients. Mean STS score was 9.0 ± 5.4. Mean aortic valve gradients was 42.2 ± 6.1 mmHg. The CoreValve and the Edwards-Sapien valve devices were used in 91.3% and 8.7% of patients, respectively. The CoreValve device was implanted via the trans-axillar route in 3 cases and via trans-femoral route in 18 cases. The trans-apical route was used in both Edwards-Sapien implantations. Procedural success was achieved in 100% of cases. One month and one year survival rates were 100% and 90%; respectively. At one month follow up, 95.7% of patients were in NYHA I/II.
Valve-in-Valve in the mitral position: mean age of patients was 73.6 ± 15 years. NYHA III/IV before the procedure was present in 100% of patients. Mean STS score was 7.7 ± 4.1. Mode of failure was severe mitral regurgitation in 100% of cases. All the procedures were performed with the Edwards-Sapien device via the trans-apical route. Procedural success was achieved in 100% of cases. One month and one year survival rates were 90% and 80%; respectively. At one month follow up, 100% of patients were in NYHA I/II.
Valve-in-Valve in the tricuspid position, was performed in a 78 year-old female patient. The patient was in NYHA IV secondary to severe tricuspid stenosis due to the deterioration of a bioprosthetic Handcock 31mm valve. An Edwards-Sapien 29mm valve was implanted via the trans-femoral vein route. The procedure went uneventful. At one month follow up the patient was in NYHA-FC II.
In our experience, the Valve-in-Valve procedure for the treatment of failed mitral, aortic and tricuspid bio-prosthetic valves, using multiple access techniques and available devices, led to significant symptomatic improvement, low peri-procedural morbidity and low mortality rates.