Author + information
- Azeem Latib, MB, BCh and
- Antonio Colombo, MD⁎ ()
- ↵⁎EMO-GVM Centro Cuore Columbus, Via Buonarroti 48, 20145 Milan, Italy
We thank Dr. Vavuranakis and colleagues for their interest in our report of “Post-implantation repositioning of the CoreValve percutaneous aortic valve” (1) and for the opportunity to discuss our experience with repositioning techniques of the CoreValve prosthesis (Medtronic Inc., Minneapolis, Minnesota), which was beyond the scope of an Image in Intervention article. At the outset, we would like to state that the best repositioning technique for the CoreValve bioprosthesis is to aim at implanting the valve correctly the first time without having to reposition the valve later. In their letter, Dr. Vavuranakis et al. allude to an important point about implantation of the CoreValve bioprosthesis, which in our opinion is not sufficiently stressed. It has now become routine practice in our institution to post-dilate all CoreValve prostheses that have more than trivial (>1+) aortic regurgitation. In the majority of cases, this additional post-dilation optimizes expansion of the nitinol stent and reduces the severity of aortic regurgitation, unless the prosthesis was truly implanted very low. Snaring and repositioning the CoreValve is a “bail-out” technique that should be attempted with caution due to the risk of embolization. A potential risk of snaring the CoreValve is that the valve moves up and the skirt covers the coronary ostium; in this event, the valve should be pulled back a little more. If the valve embolizes during this maneuver, a second valve can be implanted in the correct position. In our experience with implantation of the CoreValve in 72 patients to date, we have only performed the “snare” repositioning technique in the patient we published. Finally, the refolding and reinsertion technique is well described and is considered by some an advantage of the CoreValve Revalving System. We have used this technique successfully in 8 patients but would like to again stress that it is not without risk. Pulling the partially deployed valve back into the sheath can result in the stent struts scraping the aorta and atheroembolization. Indeed, in 1 of these 8 patients, we observed evidence of microembolization in multiple arterial beds immediately after this maneuver.
- American College of Cardiology Foundation