• Catheter Cardiovasc Interv · Dec 2011

    Performance of valve-in-valve for severe para-prosthetic leaks due to inadequate transcatheter aortic valve implantation.

    • Massimo Napodano, Valeria Gasparetto, Giuseppe Tarantini, Chiara Fraccaro, Ermela Yzeiraj, Gino Gerosa, Giambattista Isabella, and Sabino Iliceto.
    • Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy. massimo.napodano@gmail.com
    • Catheter Cardiovasc Interv. 2011 Dec 1; 78 (7): 996-1003.

    ObjectivesThis study reports on mid-term safety and performance of valve-in-valve implantation as rescue strategy to overcome acute PPL after TAVI.BackgroundModerate to severe para-prosthetic leaks (PPL) after transcatheter aortic valve implantation (TAVI) have been described with both self-expandable and balloon-expandable device.MethodsWe analyzed data regarding patients who underwent valve-in-valve implantation, enrolled in the ongoing single-center prospective registry of TAVI, the Padova University REVALVing experience Registry. All procedures were performed by a totally percutaneous approach, using the self-expanding Medtronic CoreValve (Medtronic, Minneapolis, MN).ResultsOut of 87 patients who underwent TAVI, six received valve-in-valve implantation because of persisting severe PPL, due to prosthesis malposition. In all patients, the second device was successfully deployed, with a significant reduction in aortic regurgitation: PPL was no longer appreciable in two of six patients, and it decreased from severe to mild or trivial in four patients. Four patients developed atrio-ventricular block requiring pace-maker implantation. At follow-up (6-24 months) two patients died, whereas no prosthesis-related death occurred. Transprosthesis pressure gradient, effective orifice area, and aortic regurgitation did not change at serial echocardiograms throughout the follow-up.ConclusionsValve-in-valve implantation using self-expandable bioprosthesis seems safe and highly effective to overcome severe PPL due to prosthesis malposition early after TAVI. Moreover, the implantation of two valves does not affect the performance of prosthesis at follow-up.Copyright © 2011 Wiley Periodicals, Inc.

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