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Joseph TA, Eleid MF, Cabalka AK, Maalouf JF, Rihal CS. Long‐term outcomes of melody valve‐in‐valve implantation for bioprosthetic mitral valve dysfunction. Catheter Cardiovasc Interv 2018; 93:1087-1094. [DOI: 10.1002/ccd.27988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/01/2018] [Accepted: 10/29/2018] [Indexed: 11/06/2022]
Affiliation(s)
| | - Mackram F. Eleid
- Division of Cardiovascular DiseasesMayo Clinic Rochester Minnesota
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Revuelta JM, Pomar JL. La sustitución protésica de la válvula tricúspide: de Cenicienta a Princesa. CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Shinbane JS, Saxon LA. Virtual medicine: Utilization of the advanced cardiac imaging patient avatar for procedural planning and facilitation. J Cardiovasc Comput Tomogr 2017; 12:16-27. [PMID: 29198733 DOI: 10.1016/j.jcct.2017.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/08/2017] [Accepted: 11/12/2017] [Indexed: 01/17/2023]
Abstract
Advances in imaging technology have led to a paradigm shift from planning of cardiovascular procedures and surgeries requiring the actual patient in a "brick and mortar" hospital to utilization of the digitalized patient in the virtual hospital. Cardiovascular computed tomographic angiography (CCTA) and cardiovascular magnetic resonance (CMR) digitalized 3-D patient representation of individual patient anatomy and physiology serves as an avatar allowing for virtual delineation of the most optimal approaches to cardiovascular procedures and surgeries prior to actual hospitalization. Pre-hospitalization reconstruction and analysis of anatomy and pathophysiology previously only accessible during the actual procedure could potentially limit the intrinsic risks related to time in the operating room, cardiac procedural laboratory and overall hospital environment. Although applications are specific to areas of cardiovascular specialty focus, there are unifying themes related to the utilization of technologies. The virtual patient avatar computer can also be used for procedural planning, computational modeling of anatomy, simulation of predicted therapeutic result, printing of 3-D models, and augmentation of real time procedural performance. Examples of the above techniques are at various stages of development for application to the spectrum of cardiovascular disease processes, including percutaneous, surgical and hybrid minimally invasive interventions. A multidisciplinary approach within medicine and engineering is necessary for creation of robust algorithms for maximal utilization of the virtual patient avatar in the digital medical center. Utilization of the virtual advanced cardiac imaging patient avatar will play an important role in the virtual health care system. Although there has been a rapid proliferation of early data, advanced imaging applications require further assessment and validation of accuracy, reproducibility, standardization, safety, efficacy, quality, cost effectiveness, and overall value to medical care.
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Affiliation(s)
- Jerold S Shinbane
- Division of Cardiovascular Medicine/USC Center for Body Computing, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States.
| | - Leslie A Saxon
- Division of Cardiovascular Medicine/USC Center for Body Computing, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
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Haji Zeinali AM, Abbasi K, Saheb Jam M, Yazdani S, Mortazavi SH. Transcatheter heart valve in valve implantation with Edwards SAPIEN bioprosthetic valve for different degenerated bioprosthetic valve positions (First Iranian ViV report with mid-term follow up). J Cardiovasc Thorac Res 2017; 9:152-157. [PMID: 29118948 PMCID: PMC5670337 DOI: 10.15171/jcvtr.2017.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 09/21/2017] [Indexed: 01/08/2023] Open
Abstract
Introduction: After early successful experience with transcatheter aortic valve replacement (TAVR), concept of transcatheter implantation of a new valve within a failing bioprosthetic valve emerged. Valve-in-valve (ViV) implantation seems to be a simpler option for high risk surgical patients.
Methods: We performed five ViV procedures in different valve positions. We included patients with failing bioprosthetic valves with high surgical risk due to concomitant comorbidities. We performed 2 transapical ViV procedures for failing mitral bioprosthetic valves, 1 transfemoral procedure for failing pulmonary valve and 2 transfemoral ViV implantation for failing tricuspid bioprosthetic valves.
Results: The procedures were successfully completed in all 5 cases with initial excellent fluoroscopic and echocardiographic verification. There was no valve embolization or paravalvular leakage in any of the cases. Transcatheter valve function was appropriate with echocardiography. Post procedural clinical adverse events like pleural effusion and transient ischemic attack were managed successfully. In midterm follow up all cases remained in appropriate functional class except from the transcatheter pulmonary valve which became moderately stenotic and regurgitant.
Conclusion: As the first Iranian all-comers case series with midterm follow up for ViV implantation, we had no mortality. Interestingly none of our patients had neurologic sequelae after the procedure. Midterm follow up for our patients was acceptable with good functional class and appropriate echocardiographic findings. Due to high surgical risk of the redo procedure after failing of a bioprosthetic valve especially in elderly patients with comorbidities, ViV implantation would be a good alternative to surgery for this high risk group.
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Affiliation(s)
| | - Kyomars Abbasi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Saheb Jam
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrooz Yazdani
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Schroeter T, Lurz P, Kiefer P, Wehbe M, Dähnert I. Prosthetic Pulmonary Valve Stenosis: A Different Way to Solve the Problem. Ann Thorac Surg 2015; 100:1103-5. [PMID: 26354643 DOI: 10.1016/j.athoracsur.2014.11.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/23/2014] [Accepted: 11/17/2014] [Indexed: 11/25/2022]
Abstract
To avoid a third major cardiovascular surgery in an 84-year-old man, a Melody Transcatheter Pulmonary Valve was implanted in a functionally stenotic bioprosthesis in the pulmonary position. The intervention was free of complications with good results.
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Affiliation(s)
- Thomas Schroeter
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Philipp Kiefer
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Mahmoud Wehbe
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Ingo Dähnert
- Department of Pediatric Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
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Wagner R, Daehnert I, Lurz P. Percutaneous pulmonary and tricuspid valve implantations: An update. World J Cardiol 2015; 7:167-177. [PMID: 25914786 PMCID: PMC4404372 DOI: 10.4330/wjc.v7.i4.167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/08/2015] [Accepted: 02/12/2015] [Indexed: 02/06/2023] Open
Abstract
The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology. Percutaneous procedures focusing on aortic and mitral valve replacement or interventional treatment as well as techniques of percutaneous pulmonary valve implantation have already reached worldwide clinical acceptance and routine interventional procedure status. Although techniques of percutaneous pulmonary valve implantation have been described just a decade ago, two stent-mounted complementary devices were successfully introduced and more than 3000 of these procedures have been performed worldwide. In contrast, percutaneous treatment of tricuspid valve dysfunction is still evolving on a much earlier level and has so far not reached routine interventional procedure status. Taking into account that an “interdisciplinary challenging”, heterogeneous population of patients previously treated by corrective, semi-corrective or palliative surgical procedures is growing inexorably, there is a rapidly increasing need of treatment options besides redo-surgery. Therefore, the review intends to reflect on clinical expansion of percutaneous pulmonary and tricuspid valve procedures, to update on current devices, to discuss indications and patient selection criteria, to report on clinical results and finally to consider future directions.
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Eicken A, Schubert S, Hager A, Hörer J, McElhinney DB, Hess J, Ewert P, Berger F. Percutaneous Tricuspid Valve Implantation. Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.114.002155. [DOI: 10.1161/circinterventions.114.002155] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andreas Eicken
- From the Klinik für Kinderkardiologie und angeborene Herzfehler (A.E., A.H., J. Hess, P.E.) and Klinik für Herz-und Gefäßchirurgie (J. Hörer), Deutsches Herzzentrum München, Munich, Germany; Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany (S.S., F.B.); and Department of Cardiothoracic Surgery, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (D.B.M.)
| | - Stephan Schubert
- From the Klinik für Kinderkardiologie und angeborene Herzfehler (A.E., A.H., J. Hess, P.E.) and Klinik für Herz-und Gefäßchirurgie (J. Hörer), Deutsches Herzzentrum München, Munich, Germany; Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany (S.S., F.B.); and Department of Cardiothoracic Surgery, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (D.B.M.)
| | - Alfred Hager
- From the Klinik für Kinderkardiologie und angeborene Herzfehler (A.E., A.H., J. Hess, P.E.) and Klinik für Herz-und Gefäßchirurgie (J. Hörer), Deutsches Herzzentrum München, Munich, Germany; Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany (S.S., F.B.); and Department of Cardiothoracic Surgery, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (D.B.M.)
| | - Jürgen Hörer
- From the Klinik für Kinderkardiologie und angeborene Herzfehler (A.E., A.H., J. Hess, P.E.) and Klinik für Herz-und Gefäßchirurgie (J. Hörer), Deutsches Herzzentrum München, Munich, Germany; Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany (S.S., F.B.); and Department of Cardiothoracic Surgery, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (D.B.M.)
| | - Doff B. McElhinney
- From the Klinik für Kinderkardiologie und angeborene Herzfehler (A.E., A.H., J. Hess, P.E.) and Klinik für Herz-und Gefäßchirurgie (J. Hörer), Deutsches Herzzentrum München, Munich, Germany; Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany (S.S., F.B.); and Department of Cardiothoracic Surgery, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (D.B.M.)
| | - John Hess
- From the Klinik für Kinderkardiologie und angeborene Herzfehler (A.E., A.H., J. Hess, P.E.) and Klinik für Herz-und Gefäßchirurgie (J. Hörer), Deutsches Herzzentrum München, Munich, Germany; Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany (S.S., F.B.); and Department of Cardiothoracic Surgery, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (D.B.M.)
| | - Peter Ewert
- From the Klinik für Kinderkardiologie und angeborene Herzfehler (A.E., A.H., J. Hess, P.E.) and Klinik für Herz-und Gefäßchirurgie (J. Hörer), Deutsches Herzzentrum München, Munich, Germany; Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany (S.S., F.B.); and Department of Cardiothoracic Surgery, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (D.B.M.)
| | - Felix Berger
- From the Klinik für Kinderkardiologie und angeborene Herzfehler (A.E., A.H., J. Hess, P.E.) and Klinik für Herz-und Gefäßchirurgie (J. Hörer), Deutsches Herzzentrum München, Munich, Germany; Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany (S.S., F.B.); and Department of Cardiothoracic Surgery, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (D.B.M.)
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Tzifa A, Momenah T, Al Sahari A, Al Khalaf K, Papagiannis J, Qureshi SA. Transcatheter valve-in-valve implantation in the tricuspid position. EUROINTERVENTION 2014; 10:995-9. [DOI: 10.4244/eijv10i8a168] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kuetting M, Pott D, Sedaghat A, Ng YA, Egron S, Rosefort C, Werner N, Sachweh J, Steinseifer U. Right heart transcatheter valve therapies – a review of prostheses for the pulmonary and tricuspid positions. Expert Rev Med Devices 2014; 12:163-74. [DOI: 10.1586/17434440.2015.985654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Transcatheter tricuspid valve implantation: A multicentre French study. Arch Cardiovasc Dis 2014; 107:583-91. [DOI: 10.1016/j.acvd.2014.07.051] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/17/2014] [Accepted: 07/23/2014] [Indexed: 01/27/2023]
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Filsoof DM, Snipelisky DF, Shapiro BP. Use of a melody pulmonary valve in transcatheter valve-in-valve replacement for tricuspid valve bioprosthesis degeneration. Tex Heart Inst J 2014; 41:511-3. [PMID: 25425984 DOI: 10.14503/thij-13-3544] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Bioprosthetic heart valves can degenerate and fail over time. Repeat surgery as a means of replacement increases morbidity and mortality rates, and some patients are not candidates for reoperation. A newer treatment, percutaneous transcatheter valve-in-valve implantation, might delay or substitute for invasive procedures. We present the case of a 51-year-old woman, a poor candidate for surgery who had prosthetic tricuspid valve degeneration and stenosis. We successfully performed valve-in-valve placement of a Melody(®) valve, using a procedure originally intended to treat pulmonary valve conduit obstruction or regurgitation. To our knowledge, this is among the first case reports to describe the use of the Melody pulmonary valve in transcatheter valve-in-valve replacement for prosthetic tricuspid stenosis that was otherwise not correctable. Additional data and longer follow-up periods are necessary to gain an understanding of ideal indications and selection of patients for the percutaneous transcatheter treatment of tricuspid valve stenosis.
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Abstract
PURPOSE OF REVIEW Catheter-based valve technologies have evolved rapidly over the last decade. Transcatheter aortic valve replacement (TAVR) has become a routine procedure in high-risk adult patients with calcific aortic stenosis. In patients with congenital heart disease (CHD), transcatheter pulmonary valve replacement represents a transformative technology for right ventricular outflow tract dysfunction with the potential to expand to other indications. This review aims to summarize the current state-of-the-art for transcatheter valve replacement (TVR) in CHD; the expanding indications for TVR; and the technological obstacles to optimizing TVR. RECENT FINDINGS Multiple case series have demonstrated that TVR with the Melody transcatheter pulmonary valve in properly selected patients is safe, effective, and durable in short-term follow-up. The Sapien transcatheter heart valve represents an alternative device with similar safety and efficacy in limited studies. Innovative use of current valves has demonstrated the flexibility of TVR, while highlighting the need for devices to address the broad range of postoperative anatomies either with a single device or with strategies to prepare the outflow tract for subsequent device deployment. SUMMARY The potential of TVR has not been fully realized, but holds promise in treatment of CHD.
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Gössl M, Johnson JN, Hagler DJ. Failing left ventricle to ascending aorta conduit-Hybrid implantation of a melody valve and NuMed covered stent. Catheter Cardiovasc Interv 2014; 83:778-81. [PMID: 23784974 DOI: 10.1002/ccd.25075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/09/2013] [Indexed: 11/10/2022]
Abstract
We present the case of a 36-year-old woman with increasing shortness of breath, a new 3/4 diastolic murmur, and a complex history of LV outflow tract obstruction. She has undergone multiple surgeries including the replacement of her old LV apex to ascending aorta conduit with a 20-mm Gore-Tex tube graft, addition of a 24-mm homograft sutured between the conduit and the LV apex, and insertion of a 21-mm Freestyle porcine valve conduit between the Gore-Tex tube graft and allograft at age 23. The current assessment showed a failing Freestyle conduit prosthesis leading to left heart decompensation. Due to substantial surgical risk, the patient underwent successful implantation of a Melody valve into the Gore-Tex tube and exclusion of the failing Freestyle bioprosthesis with a NuMed CP stent in a hybrid procedure. The case nicely illustrates the collaborative potential of cardiovascular surgeons and interventional cardiologists in the new arena of a hybrid operating room. Complex hybrid procedures like the current one, especially those including percutaneous placements of valves, offer therapeutic options for patients that are otherwise too high risk for conventional open heart surgery.
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Affiliation(s)
- Mario Gössl
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
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Valve-in-valve implantations: is this the new standard for degenerated bioprostheses? Review of the literature. Clin Res Cardiol 2014; 103:417-29. [PMID: 24445751 DOI: 10.1007/s00392-013-0653-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 12/09/2013] [Indexed: 02/05/2023]
Abstract
Transcatheter aortic valve implantation has established itself as an alternative treatment for patients with valvular disease. In the current context of increasing bioprosthetic valve implants and an ageing population with growing comorbidities, a less invasive approach to the treatment of bioprosthetic dysfunction would be an appealing alternative to the standard of care. Transcatheter valve-in-valve implantation could be an alternative for patients who are deemed to be a high surgical risk. The valve-in-valve procedure is a minimally invasive percutaneous procedure where a valve can be implanted directly within a failing bioprosthetic valve. This technique can be applied to dysfunctional aortic bioprosthetic valves and can also be used in the pulmonary and atrioventricular valve bioprosthesis. We review the current literature to assess whether this technique may be the new standard for degenerated bioposthesis.
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Abstract
Percutaneous implantation of valved stents is now routinely performed to treat pulmonary valve regurgitation and stenosis. In addition, there are isolated reports of implantation of valved stents in the tricuspid position to treat prosthetic tricuspid stenosis or regurgitation when a prosthetic valve ring exists. We present a case in which a patient with combined severe tricuspid valve and pulmonary valve disease was successfully treated with sequential implantation of percutaneous valved stents in a single procedure. The procedure was straightforward, of short duration, and dramatically improved the patient's functional status.
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Bhamidipati CM, Scott Lim D, Ragosta M, Ailawadi G. Percutaneous transjugular implantation of MELODY® valve into tricuspid bioprosthesis. J Card Surg 2013; 28:391-3. [PMID: 23772880 DOI: 10.1111/jocs.12128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We present the technique of transcatheter balloon expandable (MELODY®) valve-in-valve deployment in a frail octogenarian with a failed previous tricuspid bioprosthesis. In patients who are not candidates for conventional surgery, transcatheter approach provides an alternative that warrants careful consideration.
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Affiliation(s)
- Castigliano M Bhamidipati
- Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA
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Cullen MW, Cabalka AK, Alli OO, Pislaru SV, Sorajja P, Nkomo VT, Malouf JF, Cetta F, Hagler DJ, Rihal CS. Transvenous, antegrade Melody valve-in-valve implantation for bioprosthetic mitral and tricuspid valve dysfunction: a case series in children and adults. JACC Cardiovasc Interv 2013; 6:598-605. [PMID: 23683739 DOI: 10.1016/j.jcin.2013.02.010] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 01/01/2013] [Accepted: 02/02/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this study was to report the results of percutaneous valve-in-valve therapy using the Melody valve (Medtronic, Minneapolis, Minnesota) for patients with degenerated mitral and tricuspid bioprosthetic valves. BACKGROUND Open surgery for replacement of degenerated bioprosthetic valves is associated with morbidity and mortality. METHODS Nineteen patients (median age 65 years, range 10 to 88 years; 7 males) with degenerated mitral (n = 9) or tricuspid (n = 10) bioprosthetic valves underwent transvenous valve-in-valve implantation of the Melody valve. RESULTS In the mitral patients, the mean Society of Thoracic Surgeons mortality score was 13.3 ± 5.6%. All patients had a prosthetic valve mean diastolic inflow gradient ≥5 mm Hg. Moderate or worse regurgitation was present in 7 of 9 mitral and 7 of 10 tricuspid patients. Implantation of a Melody valve was successful in all. Among the mitral patients, mean diastolic gradient decreased from 12.3 ± 4.6 mm Hg to 5.2 ± 2 mm Hg (p < 0.01). Residual regurgitation was trivial to mild in 6, mild to moderate in 2, and moderate in 1 patient. Among the tricuspid patients, mean diastolic gradient decreased from 10.0 ± 4.3 mm Hg to 5.6 ± 2.5 mm Hg (p < 0.01). Residual regurgitation was trivial to mild in 9 and mild to moderate in 1 patient. New York Heart Association functional class improved in 17 of 19 patients (p < 0.01). No periprocedural deaths, myocardial infarctions, strokes, or valve embolizations occurred. Vascular access site complications occurred in 4 patients. CONCLUSIONS Percutaneous valve-in-valve implantation of the Melody valve in the mitral or tricuspid position for treatment of bioprosthetic valve dysfunction is feasible and can lead to significant symptomatic improvement in carefully selected high-risk patients.
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Affiliation(s)
- Michael W Cullen
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA
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Transcatheter Valve-in-Valve Therapies: Patient Selection, Prosthesis Assessment and Selection, Results, and Future Directions. Curr Cardiol Rep 2013; 15:341. [DOI: 10.1007/s11886-012-0341-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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