Transapical aortic 'valve-in-valve' procedure for degenerated stented bioprosthesis.

Details

Ressource 1Download: serval:BIB_76D477AFF1C1.P001 (189.35 [Ko])
State: Public
Version: author
License: Not specified
It was possible to publish this article open access thanks to a Swiss National Licence with the publisher.
Serval ID
serval:BIB_76D477AFF1C1
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Transapical aortic 'valve-in-valve' procedure for degenerated stented bioprosthesis.
Journal
European Journal of Cardio-thoracic Surgery
Author(s)
Ferrari E.
ISSN
1010-7940
1873-734X (Electronic)
ISSN-L
1010-7940
Publication state
Published
Issued date
2012
Volume
41
Number
3
Pages
485-490
Language
english
Notes
Publication types: Journal Article ; Review
Abstract
Standard surgical aortic valve replacement with a biological prosthesis remains the treatment of choice for low- and mid-risk elderly patients (traditionally >65 years of age) suffering from severe symptomatic aortic valve stenosis or insufficiency, and for young patients with formal contraindications to long-lasting anticoagulation. Unfortunately, despite the fact that several technical improvements have noticeably improved the resistance of pericardial and bovine bioprostheses to leaflet calcifications and ruptures, the risk of early valve failure with rapid degeneration still exists, especially for patients under haemodialysis and for patients <60 years of age at the time of surgery. Until now, redo open heart surgery under cardiopulmonary bypass and on cardioplegic arrest was the only available therapeutic option in case of bioprosthesis degeneration, but it carried a higher surgical risk when elderly patients with severe concomitant comorbidities were concerned. Since a few years, the advent of new transcatheter aortic valve procedures has opened new horizons in cardiac surgery and, in particular, the possibility of implanting stented valves within the degenerated stented bioprosthesis, the so-called 'valve-in-valve' (VinV) concept, has become a clinical practice in experienced cardiac centres. The VinV procedure represents a minimally invasive approach dedicated to high-risk redo patients, and published preliminary reports have shown a success rate of 100% with absence of significant valvular leaks, acceptable transvalvular gradients and low complication rate. However, this procedure is not riskless and the most important concerns are about the size mismatch and the right positioning within the degenerated bioprosthesis. In this article, we review the limited available literature about VinV procedures, underline important technical details for the positioning and provide guidelines to prevent valve-prosthesis mismatch comparing the three sizes of the only commercially available transapical device, the Edwards Sapien, with the inner diameter of three of the most commonly used stented bioprostheses.
Keywords
Aged, Aged, 80 and over, Bioprosthesis, Female, Fluoroscopy, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation/instrumentation, Heart Valve Prosthesis Implantation/methods, Humans, Patient Selection, Prosthesis Design, Prosthesis Failure, Prosthesis Fitting, Reoperation/instrumentation, Reoperation/methods, Stents, Surgical Procedures, Minimally Invasive/instrumentation, Surgical Procedures, Minimally Invasive/methods, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
19/05/2012 19:55
Last modification date
25/09/2019 7:09
Usage data