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Valve-in-valve concept - a single center experience for redo aortic valve therapy.
Philipp Kiefer, David M. Holzhey, Axel Linke, Gerhard Schuler, Joerg Seeburger, Marcel Vollroth, Friedrich W. Mohr.
Heart Center Leipzig, Leipzig, Germany.

OBJECTIVE: We herein present our experience with transapical transcatheter aortic valve-in-valve procedure as an alternative for high risk redo surgery.
METHODS: Our institutional database was retrospectively screened for patients who underwent transapical aortic valve implantation (TA AVI) since March 2007. A total of 18 patients (12 male) were detected to have received a valve-in-valve implantaion. Mean age was 77.6 ± 7.3 years and all patients were in New York Heart Association (NYHA) functional class III. The perioperative risk was estimated using log EuroScore (26.3 ± 12.2%). Mean follow up time was 708 days.
RESULTS: In all patients highly calcified and stenotic AV-prostheses were diagosed (max./ mean transvalvular pressure gradient: dPmax 64.7 ± 19,1 mmHg, dPmean 37.1 ± 9,9 mmHg, aortic valve area: 0.8 ± 0.2 cm2). All patients underwent standard TA AVI procedere following the valve-in-valve concept using the Edwards Sapiens valve with a procedural success of 100%. Early postoperative course was uneventful in all patients. Intra- and postoperative hemodynamic function was highly acceptable (grade of aortic insufficiency: 0.3 ± 0.7 and a dPmax 16.2 ± 11.7 mmHg, dPmean 10.3 ± 6.1 mmHg). Thirty day mortality was 16.6%. Cause of death was respiratory failure in all three patients.
CONCLUSIONS: TA AVI as valve-in-valve was feasible and associated with good perioperative results in this high risk patient population.


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