Single and multicentre TAVI registries
Transcatheter valve-in-valve implantation in degenerated aortic bioprostheses via transfemoral access with the Edwards SAPIEN XT transcatheter heart valve
Aims: Surgical treatment of degenerated aortic bioprostheses is associated with an increased risk of morbidity and mortality, especially in elderly patients with significant comorbidities. Therefore, transcatheter aortic valve implantation (TAVI) performed as valve-in-valve (VIV) technique appears as an attractive alternative treatment option. We report on a case series of seven patients with dysfunctional bioprosthetic aortic heart valves who have been treated with TAVI via transfemoral access.
Methods and results: Valve-in-valve implantation using the Edwards SAPIEN XT bioprosthesis (Edwards Lifesciences LLC, Irvine, CA, USA) was performed in eight patients (three men, five women, mean age 85.3±6.1 years) with a high operative risk (logistic EuroSCORE 27.2±7.3). Six patients underwent TAVI because of high-grade stenosis of the aortic bioprosthesis, whereas two patients presented with a high-grade regurgitation. All patients suffered from NYHA Class III-IV dyspnoea during admission. TAVI was successfully performed via transfemoral access under local anaesthesia with mild analgesic medication in all cases. Mild aortic regurgitation occurred in three patients while no permanent pacemaker implantation was required. Major cardiac events or cerebrovascular events did not occur. One aneurysm spurium, with the need of one blood transfusion, occurred. All patients improved at least one NYHA Class within 30 days.
Conclusions: TAVI for degenerated aortic bioprostheses, using the Edwards SAPIEN XT valve via transfemoral access is a feasible option for patients at high surgical risk.
