Transcarotid aortic valve-in-valve implantation for degenerated stentless aortic root conduits with severe regurgitation: a case series

Huber, Christoph; Praz, Fabien; O'Sullivan, Crochan J.; Langhammer, Bettina; Glökler, Steffen; Stortecky, Stefan; von Allmen, Regula S.; Meier, Bernhard; Carrel, Thierry; Englberger, Lars; Windecker, Stephan; Wenaweser, Peter (2015). Transcarotid aortic valve-in-valve implantation for degenerated stentless aortic root conduits with severe regurgitation: a case series. Interactive cardiovascular and thoracic surgery, 20(6), pp. 694-700. Oxford University Press 10.1093/icvts/ivv053

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OBJECTIVES Transcatheter aortic valve implantation (TAVI) is routinely performed via the transfemoral and the transapical route. Subclavian and direct aortic access are described alternatives for TAVI. Recently, the transcarotid approach has been shown to be feasible among patients with limited vascular access and severe native aortic valve stenosis. We aim to investigate the feasibility of transcatheter aortic valve-in-valve implantation via the transcarotid access in patients with severe aortic regurgitation due to degenerated stentless Shelhigh conduits using the 29 mm Medtronic CoreValve bioprosthesis. METHODS Three patients with complex vascular anatomy undergoing transcatheter valve-in-valve implantation via the transcarotid route were enrolled in the study. The procedure was performed under general anaesthesia using surgical cut-down to facilitate vascular access. Immediate procedural results as well as echocardiographic and clinical outcomes after 30 days and 6 months of the follow-up were recorded and analysed. RESULTS All three patients underwent unproblematic TAVI and experienced dramatic improvement of symptoms. Mean transvalvular gradient was 3, 6 and 11 mmHg, respectively. Effective orifice area ranged between 1.7 and 2.2 cm(2). Only mild paravalvular regurgitation was detected by echocardiography after 30 days of the follow-up. CONCLUSIONS The transcarotid approach can be safely performed for valve-in-valve procedures using the Medtronic CoreValve in patients with limited vascular access. It enables accurate positioning and implantation of the prosthesis.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Huber, Christoph; Praz, Fabien; O'Sullivan, Crochan John; Langhammer, Bettina; Glökler, Steffen; Stortecky, Stefan; von Allmen, Regula Sybille; Meier, Bernhard; Carrel, Thierry; Englberger, Lars; Windecker, Stephan and Wenaweser, Peter Martin

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1569-9293

Publisher:

Oxford University Press

Language:

English

Submitter:

Daniela Huber

Date Deposited:

14 Dec 2015 11:21

Last Modified:

14 Dec 2015 11:21

Publisher DOI:

10.1093/icvts/ivv053

PubMed ID:

25776924

Uncontrolled Keywords:

Aortic regurgitation Transcatheter aortic valve implantation Valve-in-valve Valvular heart disease

BORIS DOI:

10.7892/boris.74083

URI:

https://boris.unibe.ch/id/eprint/74083

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