Author + information
- Received September 18, 2013
- Revision received October 26, 2013
- Accepted November 7, 2013
- Published online July 1, 2014.
- Stephan Haussig, MD,
- Gerhard Schuler, MD and
- Axel Linke, MD∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Axel Linke, Department of Internal Medicine/Cardiology, University of Leipzig, Germany, Strümpellstrasse 39, 04289 Leipzig, Germany.
A 70-year-old man with a prior aortic valve replacement was referred because of newly diagnosed, severe aortic regurgitation. Three years ago, he underwent a successful surgical aortic valve replacement with a 23-mm St. Jude Medical Trifecta valve (St. Jude Medical, St. Paul, Minnesota) because of severe aortic stenosis. Current echocardiography revealed valve failure leading to severe, transvalvular aortic regurgitation (Figs. 1A and 1B, Online Videos 1 and 2).
Since 2010, the Trifecta (Fig. 1C) aortic valve, which is supposed to open more fully and efficiently, and therefore to perform like a natural heart valve, has been commercially available in Europe (1). Given the patient's comorbidities (pulmonary hypertension, chronic obstructive lung disease, and redo surgery) and frailty (neurological dysfunction secondary to Parkinson disease), a transcatheter aortic valve implantation (TAVI) was discussed with the patient (additive/logistic EuroSCORE 13%/43%, STS Score 3.5%) for redo surgery. To the best of our knowledge, this is the first description of a successful 23-mm Medtronic CoreValve Evolut (MCV) (Medtronic, Minneapolis, Minnesota) implantation into a failing Trifecta valve.
Based on the pre-operative computed tomography, the coronary origin was determined to be high enough and the aortic bulbus wide enough to accommodate the Trifecta valve leaflets, which were pushed aside by the MCV, and coronary occlusion did not occur. The TAVI procedure—performed without pre-dilation—was uneventful (Figs. 1D and 1E, Online Video 3) with an intended MCV implantation depth of 8 mm. Post-procedural assessment confirmed an excellent result after valve-in-valve implantation, with no evidence of residual aortic regurgitation or patient-prosthesis mismatch (Figs. 1E, 1F, and 1G, Online Videos 3 and 4; 3-dimensional reconstruction of the valve-in-valve construct: Figs. 1H and 1I, and Online Video 5).
The patient reported a significant improvement in symptoms (no angina pectoris, New York Heart Association functional class I to II) in the presence of good CoreValve Evolut function (mean gradient of 10 mm Hg, no aortic regurgitation) at 6-month follow-up. This case extends our current knowledge of valve-in-valve treatment using self-expanding valves (2). It shows that even high-risk patients with failing bioprosthetic valves, in which the leaflets are attached to the exterior of the valve stent, can be safely treated by CoreValve Evolut implantation, given that the aortic sinus is wide enough.
For supplemental videos, please see the online version of this article.
Dr. Linke is a consultant to Medtronic and St. Jude Medical; has received speaker honoraria from Edwards Lifesciences, Medtronic, St. Jude Medical, and Boston Scientific; and is a proctor for Medtronic, Edwards Lifesciences, and St. Jude Medical. Prof. Schuler and Dr. Haussig have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 18, 2013.
- Revision received October 26, 2013.
- Accepted November 7, 2013.
- American College of Cardiology Foundation
- Holzhey D.,
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