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      Transcatheter Aortic Valve Replacement for Sutureless Bioprosthetic Valve Tilting Resulting in Severe Paravalvular Leak

      case-report

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          Abstract

          Severe paravalvular leak (PVL) may be complicated by heart failure and haemolysis. PVL management is challenging, especially when the gap is large. We describe a case of PVL due to tilting of a sutureless biological prosthesis successfully treated by transcatheter aortic valve replacement (TAV-in-SAV).

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          Impact of paravalvular regurgitation on the mid-term outcome after transcatheter and surgical aortic valve replacement

          Teemu Laakso, Mika Laine, Noriaki Moriyama … (2020)
          The aim of this study was to evaluate the incidence and prognostic impact of paravalvular regurgitation (PVR) on the outcome after transcatheter (TAVR) and surgical aortic valve replacement (SAVR) for aortic stenosis. The nationwide FinnValve registry included data on 6463 consecutive patients who underwent TAVR (n = 2130) or SAVR (n = 4333) with a bioprosthesis for the treatment of aortic stenosis during 2008–2017. The impact of PVR at discharge after TAVR and SAVR on 4-year mortality was herein investigated. The rate of mild PVR was 21.7% after TAVR and 5.2% after SAVR. The rate of moderate-to-severe PVR was 3.7% after TAVR and 0.7% after SAVR. After TAVR, 4-year survival was 69.0% in patients with none-to-trace PVR, 54.2% with mild PVR [adjusted hazard ratio (HR) 1.64, 95% confidence interval (CI) 1.35–1.99] and 48.9% with moderate-to-severe PVR (adjusted HR 1.61, 95% CI 1.10–2.35). Freedom from PVR-related reinterventions was 100% for none-to-mild PVR and 95.2% for moderate-to-severe PVR. After SAVR, mild PVR (4-year survival 78.9%; adjusted HR 1.29, 95% CI 0.93–1.78) and moderate-to-severe PVR (4-year survival 67.8%; adjusted HR 1.36, 95% CI 0.72–2.58) were associated with worse 4-year survival compared to none-to-trace PVR (4-year survival 83.7%), but the difference did not reach statistical significance in multivariable analysis. Freedom from PVR-related reinterventions was 99.5% for none-to-trace PVR patients, 97.9% for mild PVR patients and 77.0% for moderate-to-severe PVR patients. This multicentre study showed that both mild and moderate-to-severe PVR were independent predictors of worse survival after TAVR. Mild and moderate-to-severe PVR are not frequent after SAVR, but tend to decrease survival also in these patients. ClinicalTrials.gov Identifier: NCT03385915.
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            Sutureless aortic valve replacement in patients who have bicuspid aortic valve.

            Anthony Nguyen, William Fortin, Amine Mazine … (2015)
            Bicuspid aortic valve (BAV) is generally considered to be a contraindication to sutureless aortic valve replacement (AVR). The aim of this study was to evaluate the feasibility and perioperative outcomes of this technique in patients with BAV.
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              Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation: prognostic implications

              Uri Landes, Aviram Hochstadt, Lisa Manevich … (2023)
              Paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) is associated with increased morbidity and mortality. The effect of transcatheter interventions to treat PVR after the index TAVI was investigated. A registry of consecutive patients who underwent transcatheter intervention for ≥ moderate PVR after the index TAVI at 22 centers. The principal outcomes were residual aortic regurgitation (AR) and mortality at 1 year after PVR treatment. A total of 201 patients were identified: 87 (43%) underwent redo-TAVI, 79 (39%) plug closure, and 35 (18%) balloon valvuloplasty. Median TAVI-to-re-intervention time was 207 (35; 765) days. The failed valve was self-expanding in 129 (63.9%) patients. The most frequent devices utilized were a Sapien 3 valve for redo-TAVI (55, 64%), an AVP II as plug (33, 42%), and a True balloon for valvuloplasty (20, 56%). At 30 days, AR ≥ moderate persisted in 33 (17.4%) patients: 8 (9.9%) after redo-TAVI, 18 (25.9%) after plug, and 7 (21.9%) after valvuloplasty (P = 0.036). Overall mortality was 10 (5.0%) at 30 days and 29 (14.4%) at 1 year: 0, 8 (10.1%), and 2 (5.7%) at 30 days (P = 0.010) and 11 (12.6%), 14 (17.7%), and 4 (11.4%) at 1 year (P = 0.418), after redo-TAVI, plug, and valvuloplasty, respectively. Regardless of treatment strategy, patients in whom AR was reduced to ≤ mild had lower mortality at 1 year compared with those with AR persisting ≥ moderate [11 (8.0%) vs. 6 (21.4%); P = 0.007]. This study describes the efficacy of transcatheter treatments for PVR after TAVI. Patients in whom PVR was successfully reduced had better prognosis. The selection of patients and the optimal PVR treatment modality require further investigation.
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                Author and article information

                Contributors
                Philippe Garot
                Journal
                Journal ID (nlm-ta): JACC Case Rep
                Journal ID (iso-abbrev): JACC Case Rep
                Title: JACC Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2666-0849
                Publication date PMC-release: 23 February 2024
                Publication date Collection: 03 April 2024
                Publication date (Electronic): 23 February 2024
                Volume: 29
                Issue: 7
                Electronic Location Identifier: 102270
                Affiliations
                [a ]Institut Cardiovasculaire Paris-Sud, Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
                [b ]Hôpital Privé Parly 2, Ramsay-Santé, Le Chesnay, France
                Author notes
                [∗ ] Address for correspondence: Dr Philippe Garot, Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, 6 avenue du Noyer Lambert, 91300 Massy, France. p.garot@ 123456angio-icps.com
                Article
                Publisher Item ID: S2666-0849(24)00051-2 Publisher ID: 102270
                DOI: 10.1016/j.jaccas.2024.102270
                PMC ID: 11031669
                PubMed ID: 38645286
                SO-VID: 0ecfd9c0-f1eb-491b-8b51-578e9000a55a
                Copyright © © 2024 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 21 September 2023
                Date revision received : 5 January 2024
                Date accepted : 26 January 2024
                Categories
                Subject: Valvular Disease
                Subject: Case Report: Clinical Case

                Keywords: cardiac ct-scan,paravalvular leak,sutureless,transcatheter aortic replacement valve
                Data availability:
                Keywords: cardiac ct-scan, paravalvular leak, sutureless, transcatheter aortic replacement valve

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