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Transcatheter aortic valve and coronary occlusion

Silvia Maggio, Alessia Gambaro, Roberto Scarsini, Flavio Ribichini
Transcatheter aortic valve implantation is becoming an attractive and promising alternative to redo surgery for aortic bioprosthetic valves degeneration, especially in high-risk patients. However, valve-in-valve transcatheter aortic valve implantation itself carries some procedural risks and potential challenges that interventionists must be aware of. An accurate preprocedural planning is fundamental for the prevention of potentially fatal complications. This case describes a novel strategy of simultaneous right and left coronary artery stenting preventing bilateral coronary obstruction in a patient with a stentless surgical aortic valve and extremely low origin of the 2 coronary arteries...
March 31, 2017: Interactive Cardiovascular and Thoracic Surgery
Masaki Ito, Norio Tada, Tatsushi Ootomo, Naoto Inoue
Transcatheter aortic valve implantation is an established alternative and less invasive procedure to replace heart valves in symptomatic aortic stenosis patients; however, severe, life-threatening complications still exist. Coronary artery occlusion is a primary complication. We report a case of left main coronary artery occlusion after transcatheter aortic valve replacement, which was ameliorated using a double stent implantation technique.
March 29, 2017: Cardiovascular Intervention and Therapeutics
Anita W Asgar, Eric Horlick, Kevin McKenzie, Neil Brass, Warren J Cantor, Albert Chan, Anthony Della Siega, Jean Francois Gobeil, Saleem Kassam, Michael P Love, Samer Mansour, Giuseppe Martucci, Najaf Nadeem, Madhu K Natarajan, Vernon Paddock, Josep Rodés-Cabau, Mouhieddin Traboulsi, James L Velianou, Robert C Welsh, David Wood, John G Webb
Cardiovascular disease encompasses coronary artery disease and valvular heart disease, and the prevalence of both increases with age. Over the past decade, the landscape of interventional cardiology has evolved to encompass a new set of percutaneous procedures outside the coronary tree, including transcatheter aortic valve implantation, transcatheter mitral valve repair, and left atrial appendage occlusion. These interventions have sparked a new discipline within interventional cardiology referred to as structural heart disease (SHD) intervention...
December 13, 2016: Canadian Journal of Cardiology
Sundeep S Kalra, Sami Firoozi, James Yeh, Daniel J Blackman, Shabnam Rashid, Simon Davies, Neil Moat, Miles Dalby, Tito Kabir, Saib S Khogali, Richard A Anderson, Peter H Groves, Darren Mylotte, David Hildick-Smith, Rajiv Rampat, Jan Kovac, Ashan Gunarathne, Jean-Claude Laborde, Stephen J Brecker
OBJECTIVES: The authors present the UK and Irish real-world learning curve experience of the Evolut R transcatheter heart valve. BACKGROUND: The Evolut R is a self-expanding, repositionable, and fully recapturable second-generation transcatheter heart valve with several novel design features to improve outcomes and reduce complications. METHODS: Clinical, procedural, and 30-day outcome data were prospectively collected for the first 264 patients to receive the Evolut R valve in the United Kingdom and Ireland...
February 13, 2017: JACC. Cardiovascular Interventions
Guillermo Careaga-Reyna, José Luis Lázaro-Castillo, Carlos Alberto Lezama-Urtecho, Enriqueta Macías-Miranda, Juan José Dosta-Herrera, José Galván Díaz
BACKGROUND: Aortic stenosis is a frequent disease in the elderly, and is associated with other systemic pathologies that may contraindicate the surgical procedure. Another option for these patients is percutaneous aortic valve implantation, which is less invasive. We present our initial experience with this procedure. MATERIAL AND METHODS: Patients with aortic stenosis were included once selection criteria were accomplished. Under general anaesthesia and echocardiographic and fluosocopic control, a transcatheter aortic valve was implanted following s valvuloplasty...
December 9, 2016: Cirugia y Cirujanos
Paweł Kleczyński, Maciej Bagieński, Artur Dziewierz, Łukasz Rzeszutko, Danuta Sorysz, Jarosław Trębacz, Robert Sobczyński, Marek Tomala, Maciej Stąpór, Dariusz Dudek
PURPOSE: Restoration of quality of life (QoL) and improvement of clinical outcomes is crucial in elderly patients undergoing transcatheter aortic valve implantation (TAVI). We sought to evaluate changes in QoL and all-cause mortality 12 months after TAVI. METHODS: A total of 101 patients who underwent TAVI were included. Patients were followed for 12 months. QoL was assessed at baseline and at 1, 6 and 12 months after TAVI using EQ-5D-3L with a visual analog scale (VAS)...
October 10, 2016: International Journal of Artificial Organs
Philipp Blanke, Jeanette Soon, Danny Dvir, Jong K Park, Christopher Naoum, Shaw-Hua Kueh, David A Wood, Bjarne L Norgaard, Kapilan Selvakumar, Jian Ye, Anson Cheung, John G Webb, Jonathon Leipsic
Valve-in-valve implantation of a transcatheter heart valve into a failed bioprosthetic heart valve has emerged as a treatment alternative to repeat conventional surgery. This requires careful pre-procedural assessment using non-invasive imaging to identify patients at risk for procedure related adverse events, such as ostial coronary occlusion. Herein we report how to comprehensively assess aortic root anatomy using computed tomography prior to transcatheter valve implantation for failed bioprosthetic aortic valves...
November 2016: Journal of Cardiovascular Computed Tomography
Gang Zhang, Jun Luo, Guo Chen
This paper discusses two male patients with severe aortic stenosis, whose right coronary arteries (RCA) were completely occluded during transcatheter aortic valve implantation (TAVI), leading to fatal hemodynamic disorder. Occlusions of RCA complicated by TAVI are rare. In addition, emergency cardiopulmonary bypass (CPB) played a critical role in rescuing our second patient. Both patients were admitted for "severe aortic stenosis," and TAVIs were performed. The first patient's blood pressure immediately dropped to 70/40 mmHg after the balloon expansion and did not increase much after the administration of aramine or fluid therapy...
September 2016: Frontiers of Medicine
Akira Tsujimura, Naritatsu Saito, Kenji Minakata, Takeshi Kimura
A 92-year-old woman was admitted to a hospital with severe aortic valve stenosis for transcatheter aortic valve implantation (TAVI). TAVI was performed under general anaesthesia. After balloon valvuloplasty, the patient became hypotensive and transesophageal echocardiography showed severe aortic regurgitation with severely depressed left ventricular wall motion. A 26 mm Sapien XT valve was deployed. However, the ventricular wall motion was still severely depressed. Coronary angiography showed occlusion of the mid-left anterior descending (LAD) artery...
July 7, 2016: BMJ Case Reports
Pawel Kleczynski, Artur Dziewierz, Maciej Bagienski, Lukasz Rzeszutko, Danuta Sorysz, Jaroslaw Trebacz, Robert Sobczynski, Marek Tomala, Andrzej Gackowski, Dariusz Dudek
OBJECTIVES: The aim of the study was to compare 12-month mortality rate of patients with and without complete coronary revascularization before transcatheter aortic valve implantation (TAVI). BACKGROUND: There are limited data on the impact of coronary artery disease burden in patients with severe aortic stenosis undergoing TAVI. METHODS: One hundred and one consecutive patients undergoing TAVI were enrolled. Of them 16 (15.8%) had an incomplete coronary revascularization...
August 2016: Journal of Interventional Cardiology
James Cockburn, Maureen Dooley, Jessica Parker, Andrew Hill, Nevil Hutchinson, Adam de Belder, Uday Trivedi, David Hildick-Smith
BACKGROUND: Redo surgery for degenerative bioprosthetic aortic valves is associated with significant morbidity and mortality. Report results of valve-in-valve therapy (ViV-TAVI) in failed supra-annular stentless Freedom Solo (FS) bioprostheses, which are the highest risk for coronary occlusion. METHODS: Six patients with FS valves (mean age 78.5 years, 50% males). Five had valvular restenosis (peak gradient 87.2 mm Hg, valve area 0.63 cm(2) ), one had severe regurgitation (AR)...
February 15, 2017: Catheterization and Cardiovascular Interventions
Emiliano Navarra, Zahra Mosala Nezhad, Xavier Bollen, Charles-Edouard Gielen, Stefano Mastrobuoni, Laurent De Kerchove, Benoit Raucent, Parla Astarci
Transcatheter aortic valve implantation was introduced into clinical practice in 2002 as a rescue approach in patients presenting with symptomatic severe aortic stenosis but not eligible for conventional aortic valve replacement. This technique allows implantation of a balloon expandable bioprosthesis without resection of the native aortic valve. Several complications are described as a consequence of the residual highly calcified valve being squeezed against the aortic wall by the stent of the implant. This can result in deformation of the metal stent and paravalvular leakage, risk of occlusion of the coronary ostia, or central and peripheral embolization of valvular debris...
September 2016: European Journal of Cardio-thoracic Surgery
José Ramón López-Mínguez, Victoria Millán-Núñez, Reyes González-Fernández, Juan Manuel Nogales-Asensio, María Eugenia Fuentes-Cañamero, Antonio Merchán-Herrera
Transcatheter aortic valve replacement (TAVR) is an increasingly common procedure for the treatment of aortic stenosis in elderly patients with comorbidities that prevent the use of standard surgery. It has been shown that implantation without aortic regurgitation is related to lower mortality. Mild paravalvular regurgitation is inevitable in some cases due to calcification of the aortic annulus and its usually somewhat elliptical shape. Central regurgitation is less common, but has been associated with valve overdilatation in cases in which reduction of paravalvular regurgitation was attempted after the initial inflation...
April 2016: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
Stephane Fournier, Pierre Monney, Christan Roguelov, Andrea Zuffi, Juan F Iglesias, Salah D Qanadli, Cecile Courbon, Eric Eeckhout, Olivier Muller
OBJECTIVES: Management of degenerated aortic valve bioprosthesis classically requires redo surgery, but transcatheter aortic valve-in-valve implantation is becoming a valid alternative in selected cases. In the case of a degenerated Mitroflow bioprosthesis, TAVR is associated with an additional challenge due to a specific risk of coronary occlusion. We aimed to assess the safety and feasibility of transfemoral valve-in-valve implantation of the new Edwards Sapien 3 (Edwards Lifesciences) in a degenerated Mitroflow bioprosthesis (Sorin Group, Inc)...
October 2015: Journal of Invasive Cardiology
Holger Eggebrecht, Rajendra H Mehta
AIMS: In Germany, all transcatheter aortic valve implantations (TAVI) and surgical aortic valve replacements (sAVR) are registered within an obligatory quality assurance programme led by the independent AQUA Institute. We have summarised patient and procedural characteristics, complication and mortality rates as reported in the annual, German language AQUA quality reports, freely accessible online, in order to provide a comprehensive overview of developments between 2008 and 2014. METHODS AND RESULTS: Since 2008, a total of 71,927 isolated sAVR and 48,353 TAVI procedures have been performed in Germany...
January 22, 2016: EuroIntervention
Nobuyuki Furukawa, Werner Scholtz, Nikolaus Haas, Stephan Ensminger, Jan Gummert, Jochen Börgermann
An 81-year-old man with high-grade aortic valve stenosis and status post-coronary artery bypass grafting and supracoronary replacement of the ascending aorta was referred for transcatheter aortic valve implantation. He was in New York Heart Association class III and had dyspnea. After appropriate screening, we implanted a 29-mm SAPIEN XT valve (Edwards Lifesciences, Irvine, CA USA) through a transapical approach because of severe peripheral arterial occlusive disease. Postinterventional aortography revealed correct positioning and function of the valve and free coronary ostia but contrast extravasation in the vicinity of the interposed vascular prosthesis, resulting in severe luminal narrowing...
July 2015: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Marco Vola, Antoine Gerbay, Salvatore Campisi, Claire Thulane, François Fuzellier
A case is presented of the early degeneration of a 21 mm SOLO stentless valve concomitant with severe mitral regurgitation (MR). Transcatheter valve-in-valve implantation was considered in this high-risk case (logistic EuroSCORE 29.3%), but was dismissed because of the risk of coronary occlusion, an absence of visual landmarks, and the impossibility to treat the MR. Following the implantation of a 27 mm Medtronic Hancock II mitral bioprosthesis, the leaflets of the SOLO valve were removed, and a 19 mm 3f Enable sutureless bioprosthesis delivered into the remaining sewing belt of the stentless valve...
March 2015: Journal of Heart Valve Disease
Fausto Castriota, Caterina Cavazza, Gioel Gabrio Secco, Antonio Micari, Alberto Cremonesi
AIMS: Transcatheter aortic valve-in-valve implantation is an emerging alternative to conventional surgical aortic valve replacement (SAVR) in patients with degenerated aortic bioprostheses. This procedure presents a high risk of coronary occlusion, especially during treatment of patients implanted with a bioprosthesis with a lower distance between the leaflets and the coronary ostia, such as the Mitroflow valve (Sorin S.p.A., Milan, Italy). In this report we aim to describe the safety and feasibility of transfemoral valve-in-valve implantation of a new-generation Lotus™ Aortic Valve Replacement System (Boston Scientific, Marlborough, MA, USA) in a case of degenerated Mitroflow bioprostheses...
April 20, 2016: EuroIntervention
Gregory Suero, Moneal Shah, Rachel Hughes-Doichev
Blood cysts of the heart are benign cardiovascular tumors found incidentally in approximately 50% of infants who undergo autopsy at less than 2 months of age. These congenital cysts, frequently present on the atrioventricular valves of infants, are exceedingly rare in adults. Nonetheless, in adults, cardiac blood cysts have been found on the mitral valve, papillary muscles, right atrium, right ventricle, left ventricle, and aortic, pulmonic, and tricuspid valves. Reported complications include left ventricular outflow obstruction, occlusion of the coronary arteries, valvular stenosis or regurgitation, and embolic stroke...
February 2015: Texas Heart Institute Journal
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