Search

Objectives The aim of this study was to evaluate early results of valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) versus redo surgical aortic valve replacement (SAVR) fo...

Background: Patients with aortic stenosis (AS) and small aortic annulus (SAA) who undergo surgical aortic valve replacement (SAVR) are more likely to receive smaller prostheses, predisposing them to prosthesis patient-mismatch (PPM). Since the Ozaki Procedure (aortic valve neocuspidization–AVNeo) has proved promising, we aimed to assess its immediate results in this scenario. Methods: AVNeo was performed in 106 consecutive patients from January 2017 to March 2019 at three centers. The records were prospectively collected and reviewed retrospectively. Most of the patients were older than 60 years and 97.2% had AS. Preoperative echocardiography showed average peak pressure gradient of 64.9±20.7mmHg and mean pressure gradient of 46.0±12.2mm Hg for patients with AS and an annular diameter of 19.8±1.1mm for all patients. EOA and iEOA averaged 0.7±0.2 cm2 and 0.4±0.2cm2/m2 before surgery, respectively. Results: There was no conversion to SAVR. Four patients needed reoperation for bleeding, but none needed reoperation due to early infective endocarditis. Median intensive care unit and hospital length of stay were 1.5±1.2 and 13.7± 5.1 days, respectively. There were 2 in-hospital deaths due to non-cardiac causes. Postoperative peak pressure gradient averaged 11.8±5.9mmHg and mean pressure gradient averaged 7.3±3.5mmHg, which means statistically significant average decreases of 58.1 and 38.7 mmHg, respectively. Postoperative EOA and iEOA averaged 2.5±0.4cm2 and 1.3±0.3cm2/m2, which means statistically significant average increases of 1.8cm2 and 0.9cm2/m2, respectively. Conclusions: AVNeo is feasible and reproducible with good immediate results. Our findings show that AVNeo produces immediate postoperative low-pressure gradients, larger EOA and minimal regurgitation of the aortic valve. CA extern

Transcatheter aortic valve replacement (TAVR) has become an equivalent alternative to surgical aortic valve replacement also in patients at low surgical risk. Prosthetic valve endocarditis after TAVR (TAVR-PVE) is a dangerous complication with the highest mortality rate among endocarditis patients. Only a minority of patients receive surgical treatment of TAVR-PVE. We present a case of surgical treatment of TAVR-PVE in a 75-year-old patient. The success of the treatment is based on the reduction of the operative trauma and length of the procedure with the use of minimally invasive right-sided thoracotomy and the Perceval sutureless aortic valve prosthesis (LivaNova, London, United Kingdom).

Korrespondenz zu 10.1016/j.athoracsur.2019.04.104