Conflict of interest: Giambattista Isabella is a physician proctor for Edwards Lifesciences Company. All other authors state that are no relationship concerning financial conflict of interest in connection with the article.
Valvular and Structural Heart Diseases
Performance of valve-in-valve for severe para-prosthetic leaks due to inadequate transcatheter aortic valve implantation†
Article first published online: 5 OCT 2011
Copyright © 2011 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions
Volume 78, Issue 7, pages 996–1003, 1 December 2011
How to Cite
Napodano, M., Gasparetto, V., Tarantini, G., Fraccaro, C., Yzeiraj, E., Gerosa, G., Isabella, G. and Iliceto, S. (2011), Performance of valve-in-valve for severe para-prosthetic leaks due to inadequate transcatheter aortic valve implantation. Cathet. Cardiovasc. Intervent., 78: 996–1003. doi: 10.1002/ccd.23181
Conflict of interest: Nothing to report.
- Issue published online: 21 NOV 2011
- Article first published online: 5 OCT 2011
- Manuscript Accepted: 28 MAR 2011
- Manuscript Revised: 23 MAR 2011
- Manuscript Received: 24 JAN 2011
- aortic stenosis;
- para-prosthetic leak;
- trans-catheter aortic valve implantation
Objectives: This study reports on mid-term safety and performance of valve-in-valve implantation as rescue strategy to overcome acute PPL after TAVI. Background. Moderate to severe para-prosthetic leaks (PPL) after transcatheter aortic valve implantation (TAVI) have been described with both self-expandable and balloon-expandable device.Methods: We 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). Results: Out 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. Conclusions: Valve-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. © 2011 Wiley Periodicals, Inc.