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Urgent reoperative transapical valve-in-valve shortly after a transapical aortic valve implantation

Ferrari, Enrico ; Locca, Didier ; Marcucci, Carlo ; Jeanrenaud, Xavier

In: European Journal of Cardio-Thoracic Surgery, 2014, vol. 46, no. 4, p. 748-750

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    Titre
    • Urgent reoperative transapical valve-in-valve shortly after a transapical aortic valve implantation
    Auteur
    • Ferrari, Enrico. Department of Cardiac Surgery, University of Lausanne, Lausanne, Switzerland
    • Locca, Didier. Department of Cardiology, University of Lausanne, Lausanne, Switzerland
    • Marcucci, Carlo. Department of Cardiac Anesthesia, University of Lausanne, Lausanne, Switzerland
    • Jeanrenaud, Xavier. Department of Cardiology, University of Lausanne, Lausanne, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Journal of Cardio-Thoracic Surgery, 2014, vol. 46, no. 4, p. 748-750. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:296200
    Summary
    Urgent reoperative transapical aortic valve-in-valve has never been proposed as a treatment option in case of a failed transcatheter aortic valve implantation (TAVI) or in case of worsening of an existing paravalvular leak, if this complication occurs right after, or a few days after, the primary transapical aortic valve implantation. Experienced surgeons should argue that after a transapical TAVI, the apex is damaged and fragile, with a high risk of irreparable ventricular tears and life-threatening bleeding if a second transapical procedure is scheduled during the acute phase. Nevertheless, if the patient is inoperable and the vascular status, including the ascending aorta, limits alternative accesses, the urgent reoperative transapical valve-in-valve becomes an alternative. We illustrate, for the first time ever, our experience with an 81-year old female patient who underwent a transapical (TA) TAVI with a Sapien™ XT 23 mm. The day after the procedure, the patient haemodynamically worsened in combination with a worsening of a known (grade 1-2) paravalvular leak. Thus, on postoperative day two, an urgent transapical valve-in-valve was performed, and a second Sapien™ XT 23 mm was placed, with an excellent haemodynamic result and absence of leak. The redo apical access did not appear very complicated and the postoperative recovery was uneventful