Valve-in-Valve Transcatheter Aortic Valve Implantation of an Evolut R in a Degenerated Lotus Valve
Lars O Conzelmann1*, Alexander Würth2, Bernd-Dieter Gonska2 and Uwe Mehlhorn1
1HELIOS Clinic for Cardiac Surgery Karlsruhe, Germany
2 Medical Clinic III - Department of Cardiology, Sankt Vincentius Hospital Karlsruhe, Germany
Submission: July 30, 2019; Published: August 19, 2019
*Corresponding author: Lars Oliver Conzelmann, HELIOS Clinic for Cardiac Surgery, Karlsruhe, Franz Lust Strasse 30, 78185 Karlsruhe, Germany J Cardiol
How to cite this article:Lars O Conzelmann, Alexander Würth, Bernd-Dieter Gonska, Uwe Mehlhorn. Valve-in-Valve Transcatheter Aortic Valve Implantation of an Evolut R in a Degenerated Lotus Valve. J Cardiol & Cardiovasc Ther. 2019; 14(4): 555893. DOI: 10.19080/JOCCT.2019.14.555893
Case Report
Degeneration of bioprosthesis also occurs in transcatheter aortic valve implantation. Treatment option in severe bioprosthetic failure is either surgical aortic valve replacement or transcatheter valve-in-valve implantation. Information about feasibility and outcome of the latter interventions is sparse.
In November 2016, a 79-year old lady received a transfemoral transcatheter aortic valve implantation with a Boston Scientific Lotus valve (23mm) suffering from symptomatic aortic stenosis. Intraoperatively, a permanent pacemaker was implanted due to an AV block grade III. A gradient of 27/18mmHg was measured at discharge. Exactly two years later, in November 2018, she represented with severe dyspnea. Echocardiography revealed a degenerated TAVI-bioprosthesis with an orifice area of 0.8cm² and a Pmax/mean of 90/50mmHg. Due to the restricted condition and comorbidities of this patient (logistic EuroSCORE I 32.75%) a valve-in-valve procedure was discussed. Meticulous planning including coronary angiography and CT-scan revealed an inner valve diameter of 18mm, a height of 20mm, uncritical coronary anatomy without risk of obstruction and a possible transfemoral approach. After deliberate assessment a Medtronic Evolut R 23mm seemed to fit best in this case. The valve-in-valve procedure was performed under general anesthesia. Predilation with a 20mm Balloon was performed for sizing confirmation (Video 1). Thereafter a Medtronic Evolut R 23mm was implanted uneventfully into the Lotus valve (Figure 1 & Video 2). After implantation the valvular gradient decreased to 0mmHg. Postimplantation angiography showed no aortic regurgitation and instant staining of both coronary arteries (Video 3). The patient was discharged with clear improvement. This is the first case of a successful valve-in-valve of a Medtronic Evolut R into a degenerated Lotus valve. The procedure can be done safely and easily with a good result.