scholarly journals New Mitral Annuloplasty Ring Enables Oversizing of Transcatheter Heart Valve and Prevents Central or Paravalvular Leakage

2017 ◽  
Vol 65 (06) ◽  
pp. 460-466
Author(s):  
Jan-Malte Sinning ◽  
Armin Welz ◽  
Fritz Mellert ◽  
Georg Duerr
Keyword(s):  
Mitral Regurgitation ◽  
Heart Valve ◽  
Proof Of Concept ◽  
Annuloplasty Ring ◽  
Mitral Annuloplasty ◽  
Concept Study ◽  
Paravalvular Leakage ◽  
Potential Source ◽  
Transcatheter Heart Valve ◽  
Transcatheter Valve

Background Transcatheter valve-in-ring strategies have been developed to treat recurrent mitral regurgitation (MR) after failing surgical annuloplasty. However, suboptimal THV expansion with consecutive paravalvular leakage (PVL) is a procedure-immanent issue. Methods A rigid, saddle-shaped ring was cut at four locations. The segments were reconnected with pull-springs, rearranged to the original shape, and covered with a sewing cuff. The length of the annuloplasty ring construct, including extended pull-springs, was defined by the perimeter of an appropriate THV. We deployed a Sapien XT within the new ring, expanded it to its maximum extent, and investigated the geometrical changes. Results Fluoroscopy confirmed oval, saddle-shaped ring before dilation. After THV implantation, the ring segments spread apart and pull-springs were stretched. The extended ring changed its configuration from “oval” to “round” and anchored the THV leaving no paravalvular or central gaps as potential source for PVL. Conclusion We developed an expandable annuloplasty ring that is perfectly concerted to THV implantation. This proof-of-concept study revealed no PVL and good oversizing ability that might impact future annuloplasty ring design. Further studies have to evaluate durability and device safety.

scholarly journals Transseptal Implantation of a Transcatheter Heart Valve in a Mitral Annuloplasty Ring to Treat Mitral Repair Failure

2011 ◽  
Vol 4 (4) ◽  
pp. 396-398 ◽  
Author(s):  
Dominique Himbert ◽  
Eric Brochet ◽  
Costin Radu ◽  
Bernard Iung ◽  
David Messika-Zeitoun ◽  
...  
Keyword(s):  
Heart Valve ◽  
Annuloplasty Ring ◽  
Mitral Annuloplasty ◽  
Mitral Repair ◽  
Transcatheter Heart Valve

Real-World Experience With the SAPIEN 3 Ultra Transcatheter Heart Valve: A Propensity-Matched Analysis From the United States

2021 ◽  
Vol 14 (9) ◽  
Author(s):  
Tamim M. Nazif ◽  
Thomas J. Cahill ◽  
David Daniels ◽  
James M. McCabe ◽  
Mark Reisman ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Heart Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Sapien 3 ◽  
Transcatheter Valve

Background: Paravalvular regurgitation (PVR) after transcatheter aortic valve replacement is associated with adverse clinical outcomes. The SAPIEN 3 Ultra (Ultra) is a new generation balloon-expandable transcatheter heart valve with a modified external skirt that is designed to reduce PVR, but reports of clinical and echocardiographic outcomes are limited. The aim of this study was to compare short-term outcomes of patients undergoing transcatheter aortic valve replacement with the Ultra and the original SAPIEN 3 (S3) transcatheter heart valve in a large national registry. Methods: Data from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry was used to compare patients who underwent elective, transfemoral transcatheter aortic valve replacement with the Ultra or S3 transcatheter heart valve. Clinical and echocardiographic outcomes were analyzed in a propensity-matched cohort at discharge and 30 days. Results: Patients who underwent transcatheter aortic valve replacement with Ultra (N=1324) from January 2019 to February 2020 were propensity score–matched with patients treated with S3 (N=32 982) during the same period, resulting in 1324 matched pairs. There was no difference in the rate of device success between patients treated with Ultra and S3 (97.1% versus 98.0%, P =0.11). At hospital discharge, PVR was significantly reduced with Ultra compared with S3, with mild PVR in 9.0% versus 13.9% and moderate or greater PVR in 0.1% versus 0.4% (overall P <0.01). At 30 days, there were no differences between Ultra and S3 recipients in the rates of all-cause mortality or stroke (1.8% versus 2.8%, P =0.10), major vascular complications (1.1% versus 1.0%, P =0.84), or permanent pacemaker implantation (6.4% versus 6.2%, P =0.81). Conclusions: In this propensity-matched analysis from the Transcatheter Valve Therapy Registry, the Ultra transcatheter heart valve was associated with similar procedural and 30-day clinical outcomes, but reduced incidence of PVR, compared with S3. The clinical benefit of less PVR should be evaluated in longer-term studies.

Successful first-in-man Melody transcatheter valve implant in a dehisced mitral annuloplasty ring transapical valve-in-ring implant

2014 ◽  
Vol 10 (8) ◽  
pp. 961-967 ◽  
Author(s):  
Francesco Maisano ◽  
Diana Reser ◽  
Jovana Pavicevic ◽  
Fabian Nietlispach ◽  
Oliver Gämperli ◽  
...  
Keyword(s):  
Annuloplasty Ring ◽  
Mitral Annuloplasty ◽  
Transcatheter Valve

scholarly journals Transfemoral Implantation of a Balloon-Expandable Transcatheter Valve in a Rigid Mitral Annuloplasty Ring Optimized by Post-Dilatation

2017 ◽  
Vol 10 (19) ◽  
pp. e177-e179 ◽  
Author(s):  
Damiano Regazzoli ◽  
Stefano Stella ◽  
Silvia De Pinto ◽  
Matteo Montorfano ◽  
Marco Bruno Ancona ◽  
...  
Keyword(s):  
Annuloplasty Ring ◽  
Mitral Annuloplasty ◽  
Transcatheter Valve

scholarly journals Successful mitral valve-in-ring repair of mitral annuloplasty ring dehiscence causing severe mitral regurgitation—a case report

2021 ◽  
Author(s):  
Harish Sharma ◽  
Adnan Nadir ◽  
Richard P Steeds ◽  
Sagar N Doshi
Keyword(s):  
Case Report ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Transesophageal Echocardiography ◽  
Severe Mitral Regurgitation ◽  
Annuloplasty Ring ◽  
Mitral Annuloplasty ◽  
Case Summary ◽  
Valve Implantation ◽  
Two Jets

Abstract Background Annuloplasty failure caused by ring dehiscence can lead to trans-ring and para-ring mitral regurgitation. Transcatheter treatments are available for patients at prohibitive risk of surgery. In patients unsuitable for edge-to-edge repair, valve-in-ring transcatheter mitral valve implantation has been described to treat trans-ring or para-ring jets but not both concurrently. Case summary A 78-year-old male presented with severe mitral regurgitation due to dehiscence of a 34 mm Edwards Physio II mitral annuloplasty ring. Transesophageal echocardiography showed two jets of regurgitation; trans-ring and para- ring. Repair was successfully undertaken with a valve-in-ring procedure (29 mm S3 Edwards Lifesciences). Discussion Patients with failure of mitral valve annuloplasty with trans-ring and para-ring regurgitation can be safely and effectively treated by valve-in-ring transcatheter mitral valve implantation.

scholarly journals Optimising the Haemodynamics of Aortic Valve-in-valve Procedures

2017 ◽  
Vol 12 (01) ◽  
pp. 40 ◽  
Author(s):  
Ren Jie Yao ◽  
Matheus Simonato ◽  
Danny Dvir ◽  
◽  
◽  
...  
Keyword(s):  
Aortic Valve ◽  
Heart Valve ◽  
Standard Of Care ◽  
Common Adverse Event ◽  
Mechanical Valves ◽  
Transcatheter Heart Valve ◽  
Implantation Depth ◽  
Valve In Valve ◽  
Transcatheter Valve ◽  
Valve Implantation

Bioprosthetic surgical valves are increasingly implanted during cardiac surgery, instead of mechanical valves. These tissue valves are associated with limited durability and as a result transcatheter valve-in-valve procedures are performed to treat failed bioprostheses. A relatively common adverse event of aortic valve-in-valve procedures is residual stenosis. Larger surgical valve size, supra-annular transcatheter heart valve type, as well as higher transcatheter heart valve implantation depth, have all been shown to reduce the incidence of elevated post-procedural gradients. With greater understanding of technical considerations and surgical planning, valve-invalve procedures could be more effective and eventually may become the standard of care for our increasingly ageing and comorbid population with failed surgical bioprostheses.

scholarly journals Feasibility of Transcatheter Aortic Valve Replacement in Prior Aortic Root Surgery

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Michael I. Brener ◽  
Tsuyoshi Yamabe ◽  
Jay Leb ◽  
Omar K. Khalique ◽  
Hiroo Takayama ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Valve ◽  
Aortic Root ◽  
Odds Ratio ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Transcatheter Valve ◽  
Coronary Obstruction

Background: Aortic root replacement (ARR) introduces several anatomic complexities relevant to valve-in-valve (VIV)–transcatheter aortic valve replacement (TAVR) that may (1) increase the risk of coronary obstruction, (2) necessitate transcatheter valve overexpansion to accommodate large annuli, and (3) require alternative vascular access to navigate aortic kinking. Therefore, we aimed to quantify the feasibility of VIV-TAVR in patients who underwent aortic root surgery. Methods: Postoperative computed tomography scans were reviewed for consecutive patients who underwent ARR between 2005 and 2019 to obtain measurements relevant for VIV-TAVR planning. Virtual transcatheter valve to coronary ostia distance was measured to assess the risk of coronary obstruction. Root morphologies were classified into 1 of 4 groups based on aortic graft type, aortic diameter at the sinotubular junction, sinus height, estimated transcatheter heart valve height, and diameter. VIV-TAVR was projected to be complex in patients with an aortic kink, extremely large annulus, or heightened risk of coronary obstruction. Results: Among 848 patients who underwent ARR during the 15-year study period, qualifying contrast-enhanced scans post-ARR were performed in 81 patients. Complex VIV-TAVR was anticipated in 50.6% of subjects. Patients with abnormal root anatomy experienced increased odds of complex VIV-TAVR relative to patients with normal root physiology (ie, sinotubular junction diameter>transcatheter heart valve diameter, sinus height>transcatheter heart valve height) or those who received straight tube grafts (odds ratio, 4.53 [95% CI, 1.02–20.1], P =0.046). The odds of complex VIV-TAVR were also higher among patients who underwent aortic valve replacement–ARR with a stentless bioprosthesis (stentless versus stented, odds ratio, 4.63 [95% CI, 1.40–15.3], P =0.012; stentless versus valve-sparing ARR, odds ratio, 3.78 [95% CI, 1.14–12.5], P =0.029). Conclusions: ARR patients with atypical root morphologies or those who underwent valve replacement with stentless bioprostheses may be at high risk for complex VIV-TAVR. Prospective evaluation is required to assess the impact of these conclusions on procedural feasibility.

Sign in / Sign up

Export Citation Format

Share Document