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Unique technical challenges in patients undergoing TAVR for failed aortic homografts
Author(s) -
Kislitsina Olga N.,
Szlapka Michal,
McCarthy Patrick M.,
Davidson Charles J.,
Flaherty James D.,
Sweis Ranya N.,
Kruse Jane,
Andrei Adin C.,
Cox James L.,
Malaisrie S. Christopher
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15176
Subject(s) - medicine , valve replacement , prosthesis , surgery , stenosis , cardiology , regurgitation (circulation) , aortic valve , endocarditis , stroke (engine) , aortic valve stenosis , mechanical engineering , engineering
Objective Surgical reoperation for aortic homograft structural valve degeneration (SVD) is a high‐risk procedure. Transcatheter aortic valve replacement (TAVR) for homograft‐SVD is an alternative to reoperation, but descriptions of implantation techniques are limited. This study compares outcome in patients undergoing into two groups by the type of previously implanted aortic valve prosthesis: TAVR for failed aortic homografts (TAVR‐H) or for stented aortic bioprostheses (TAVR‐BP). Methods From 2015 to 2017, TAVR was performed in 41 patients with SVD. Thirty‐three patients in the TAVR‐BP group (six for SVD of valved conduits), and eight patients in the TAVR‐H group. The Valve Academic Research Consortium criteria were used for outcome reporting purposes. Results The patients with TAVR‐BP had predominant prosthetic stenosis (94%, p = .002), whereas TAVR‐H individuals presented mostly with regurgitation (88%, p = <.001). Patients with TAVR‐H received: Sapien‐3 (6), Sapien‐XT (1), and CoreValve (1) devices. Low, 40% ventricular fixation in relation to homograft annulus was attempted to anchor the prosthesis on the homograft suture‐line. One patient with TAVR‐BP experienced intraoperative distal prosthesis migration and Type‐B aortic dissection, and two patients in the TAVR‐H group had late postoperative proximal device migration. In both groups, there was zero 30‐day mortality, stroke, or pacemaker implantation. Conclusions TAVR for failing aortic homografts may be a feasible and safe alternative to high‐risk surgical reintervention. Precise, 40%‐ventricular device positioning appears crucial for prevention of late paravalvular leak/late prosthesis migration and minimizing the risk of repeat surgical intervention.