Open AccessTransfemoral aortic valve replacement for severe aortic valve regurgitation in a patient with a pulsatile‐flow biventricular assist device
Author(s) -
Gomes Bruna,
Bekeredjian Raffi,
Leuschner Florian,
Ehlermann Philipp,
Schmack Bastian,
Ruhparwar Arjang,
Raake Philip W.,
Katus Hugo A.,
Kreusser Michael M.
Publication year - 2019
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.12384
Subject(s) - medicine , cardiology , regurgitation (circulation) , pulsatile flow , heart failure , valve replacement , heart transplantation , dilated cardiomyopathy , aortic valve , transplantation , ventricular assist device , surgery , stenosis
Severe aortic regurgitation (AR) is a rare but significant complication of ventricular assist device therapy. Experience with transcatheter aortic valve replacement (TAVR) in this setting of patients is very limited, while the scarcely reported cases exclusively refer to TAVR under continuous‐flow left ventricular assist devices. Here, we present the first successful TAVR while running a pulsatile‐flow biventricular assist device (PF‐BiVAD). Clinical data were collected based on the patient's electronic medical records after the patient's consent was obtained. We describe the case of a 57‐year‐old man in whom a PF‐BiVAD (EXCOR, Berlin Heart, Berlin, Germany) had been initially inserted after fulminant myocarditis with subsequent severe dilated cardiomyopathy as bridge‐to‐transplantation therapy. Over the following 2 years, the patient developed severe de novo AR under PF‐BiVAD therapy. This, along with progressive cardiac decompensation, led to the decision for TAVR by our heart team as a minimal invasive approach for severe AR. TAVR using two Edwards SAPIEN 3 bioprostheses as a valve‐in‐valve procedure resulted in a significant reduction of AR from severe to mild, with trace paravalvular leakage and without significant pressure gradients. The patient underwent total orthotopic heart transplantation afterwards. This is the first report of successful TAVR in a patient with severe de novo AR while running a PF‐BiVAD.