Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2016;69:1214 - Vol. 69 Num.12 DOI: 10.1016/j.rec.2016.04.001

SAPIEN XT Valve-in-valve Implantation in Stenotic Valve

Luis S. Díaz de la Llera a,, José M. Cubero Gómez a, Beatriz Jáuregui Garrido a

a Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Virgen del Rocío, Seville, Spain

Article

We present the case of a 77-year-old woman with heart failure who had undergone percutaneous aortic valve implantation in 2011 with a satisfactory initial outcome (maximum gradient [Gmax] and mean gradient [Gmean] of 19 and 11 mmHg, respectively). Her Edwards SAPIEN XT 23 mm prosthetic valve had deteriorated (Figure 1) and was severely stenotic (Figure 1) (Gmax and Gmean of 74 and 38 mmHg, respectively). The risk of postoperative death at 30 days was 15.4% in 2011 and 17.9% in 2015 according to the Society of Thoracic Surgeons scale. Our multidisciplinary team decided to perform a valve-in-valve percutaneous implantation under fluoroscopic guidance (Figure 1 and video 1 of the supplementary material).

Figure 1.

This case demonstrates that successful Edwards SAPIEN XT valve-in-valve implantation is possible. Such a procedure is risky due to the possibility of mismatch and, to our knowledge, no similar cases have been reported in the literature. Nevertheless, the strut thickness (1.2 mm) and valve thickness (0.4 mm) were known and mismatch was considered unlikely. The lack of mismatch was confirmed after implantation (Gmax and Gmean of 20 and 9 mmHg, respectively) with satisfactory valve opening (Figure 1) and closure (Figure 1) (video 2 of the supplementary material). The prosthesis initially had an internal diameter of 19 mm (Figure 2), which, given the adequate strut compression (Figure 2), decreased to 17.6 mm after the valve-in-valve procedure (Figure 2). The patient was discharged and prescribed aspirin and clopidogrel.

Figure 2.

In view of the above, we would even consider a third valve-in-valve transaortic valve implantation if necessary in the future, using a 20-mm Edwards SAPIEN XT valve.

SUPPLEMENTARY MATERIAL

Video 1

Video 2

Corresponding author: luissalvadordiaz@hotmail.com

1885-5857/© 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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