First successful transcatheter valve-in-valve implantation into a failed mechanical prosthetic aortic valve facilitated by fracturing of the leaflets: a case report. Issue 7 (30th July 2021)

• Record Type: Journal Article
• Authors: Butter, Christian; Kühnel, Ralf-Uwe; Hölschermann, Frank
• Editors: De Carlo, Marco; Pastore, Maria Concetta; Bonaros, Nikolaos; Al-Hijji, Mohammed; Mukherjee, Raul; Mehta, Vishal Shahil
• Is Part Of: European heart journal. Volume 5:Issue 7(2021)
• Publication Date: 2021-07-30
• Subjects: Transcatheter valve-in-valve implantation -- Degenerated mechanical valve -- Valve fracture -- Cerebral protection -- Bileaflet mechanical valve -- Case report; Cardiology -- Periodicals; Cardiology -- Case studies -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Case studies -- Periodicals; 616.12
• DOI: 10.1093/ehjcr/ytab130
• Languages: English
• ISSNs: 2514-2119

Abstract

Abstract: Background: Degenerated and failed bioprosthetic cardiac valves can safely be treated with transcatheter valve-in-valve implantation in patients at high risk for reoperation. So far, non-functional mechanical valves must be treated with a surgical redo. Breaking the carbon leaflets before implanting a transcatheter valve into the remaining ring has never been described before. Case summary: Here, we present the case of a 65-year-old male patient with severe heart failure, poor left ventricular function based on a fully immobile disc of his mechanical bileaflet aortic valve implanted 7 years ago. After the heart team declined to reoperate the patient due to his extremely high risk, we considered a transcatheter valve-in-valve implantation as the ultimate treatment approach. After successful interventional cracking of the leaflets in vitro, this approach, together with implanting a balloon-expandable transcatheter aortic valve replacement (TAVR) into the remaining ring, was performed under cerebral protection. The intervention resulted in a fully functional TAVR, improvement of heart function, and early discharge from the hospital. Discussion: This case demonstrates the possibility to implant a transcatheter valve successfully into a non-functional mechanical bileaflet aortic prosthesis after fracturing the carbon discs while the brain is protected by a filter system. Critical steps of the procedure were identified. This new therapeutic approach might be offered to a limited patient cohort who is not eligible for a surgical redo.