Multiplug paravalvular leak closure using Amplatzer Vascular Plugs III: A prospective registry.

BACKGROUND: Transcatheter paravalvular leak closure (TPVLC) offers a viable alternative to reoperation but optimal technical strategy is still to be defined. We present a prospective TPVLC registry in which safety and efficacy of multi-plug, single-stage approach were assessed. METHODS: Patients with heart failure (HF) symptoms caused by PVL were qualified for TPVLC by Heart Team. Ante- or retrograde access was employed for mitral while retrograde only for aortic PVLs. Two to 4 AVP 3 devices were simultaneously implanted into each PVL. Endpoints were defined according to VARC-2. RESULTS: From 64 referred patients 49, with either mechanical valves (n = 30) or stented bioprostheses, were eligible for TPVLC. PVL location was mitral (n = 29) or aortic (n = 20). In aortic group acute procedural success (APS) ratio was 100% and no MACCEs occurred. In mitral group, first-attempt TPVLC was successful in 22 cases (4/4 in transapical and 18/25 in transseptal access). Second-attempt transapical procedure followed transseptal failure in 5 patients. Mitral TPVLC ultimately proved efficient in 89.7% with 76.5% APS. Cumulatively, TPVLC was accomplished in 46 subjects (93.9%) with 78% APS. When successful, it led to a significant decrease of NT-proBNP concentration and HF symptoms regression. Periprocedural safety endpoints were met in three patients and included non-disabling stroke, and two access site-related complications. In device failure group two patients died (end-stage HF) and two others were rehospitalized. CONCLUSION: TPVLC with simultaneous deployment of multiple AVP III occluders is feasible with high device success rate and no significant periprocedural complications. The clinical benefits of reduction of HF symptoms and hemolysis are evident after 30 days and persist up to 1 year without recurrence of PVL.

Early Prosthetic Valve Dysfunction Due to Bioprosthetic Valve Thrombosis: The Role of Echocardiography.

OBJECTIVES: The purpose of this study was to review the institutional practice of surveillance transthoracic echocardiography (TTE) for diagnosing early prosthetic valve dysfunction (PVD). BACKGROUND: Bioprosthetic valve thrombosis (BPVT) is an important cause of PVD, and guidelines do not recommend routine TTE during the first 5 years after valve implantation. METHODS: The authors performed a retrospective case-control study of all suspected (imaging diagnosis) or confirmed (histopathological diagnosis) cases of BPVT from January 1997 through December 2016. Patients were matched 1:2 (age, sex, prosthesis position) to patients whose prostheses were explanted because of structural failure (SF). PVD was defined as a 50% increase above baseline gradient at valve implantation and classified as early (≤5 years) or late (>5 years) after implantation. RESULTS: There were 94 BPVT (51 suspected, 43 confirmed) and 188 SF cases; patient age 61 ± 9 years; men 61 (65%). The prosthesis positions were aortic 56%; mitral 26%; tricuspid 15%; and pulmonary 3%. Early PVD was more common in the BPVT versus SF group: 83 of 94 (88%) versus 20 of 188 (11%) (p < 0.001). Time from implantation to PVD was shorter for BPVT than SF: 26 months (interquartile range [IQR]: 12 to 43 months) versus 74 months (IQR: 48 to 102 months) (p < 0.001). At the initial PVD diagnosis, 81% of BPVT and 90% of SF patients were asymptomatic. However, BPVT patients had rapid symptomatic deterioration, requiring intervention sooner after PVD diagnosis: 6 months (IQR: 4 to 7 months) versus 51 months (IQR: 22 to 55 months) (p < 0.001). CONCLUSIONS: Most patients with PVD due to BPVT were asymptomatic at initial diagnosis, which was made based on routine surveillance TTE, often performed before 5 years. BPVT, an acute disease process, requires timely diagnosis because patient conditions rapidly deteriorate. Further studies are needed to determine whether routine surveillance TTE should be considered for patients with bioprosthetic valves to identify pre-symptomatic features of BPVT in order to provide effective, appropriate therapy.

Combined venoarterial extracorporeal membrane oxygenation and transcatheter aortic valve implantation for the treatment of acute aortic prosthesis dysfunction in a high-risk patient.

We describe the case of a patient with acute bioprosthesis dysfunction in cardiogenic shock, in whom hemodynamic support was provided by venoarterial extracorporeal membrane oxygenation, and successfully treated by transcatheter aortic valve implantation.

Rotura aguda de prótesis valvular aórtica biológica Biocor® seis años después de su implante: reporte de un caso / Acute rupture a a Biocor® aortic valve prosthesis six years after implantation

Resumen: Un hombre de 66 años portador de una prótesis valvular aórtica SJM Biocor® (Saint Jude Medical, St Paul, Minn), instalada 6 años antes, se presentó con disnea severa de rápida instalación. Mediante ecocardiografía de superficie y transesofágica se demostró insuficiencia aórtica masiva y el paciente fue reintervenido con éxito. En la operación se observó un desprendimiento parcial de la inserción del velo coronario izquierdo al anillo protésico. No había endocarditis. Se implantó una nueva prótesis biológica Trifecta® (Saint Jude Inc, St Paul, Minn) N°27. La evolución precoz y a 2 años de la intervención es muy satisfactoria.

Abstract A 66 year-old man with a SJM Biocor® (Saint Jude Medical, St Paul, Minn) implanted 6 years before developed unexpected severe dyspnea. Surface and transesophageal echocardiograms confirmed severe aortic regurgitation. The patient was rapidly re operated on. There was a partial detachment of the left coronary leaflet form the valve annulus. There was no evidence of endocarditis. A new valve (Trifecta® (Saint Jude Inc, St Paul, Minn) N°27). was inserted. Clinical course has been uneventful up to two years post surgery.

Prise en charge des patients nécessitant une réintervention cardiaque valvulaire: Expérience du service de cardiologie du CHU d'Oran / Management of patients requiring a reintervention of the heart valve: Experience of the cardiology department of University Hospital Center of Oran

Introduction - Les cardiopathies valvulaires demeurent fréquentes malgré l'amélioration des conditions sanitaires qui ont permis la réduction de l'incidence du rhumatisme articulaire aigu (RAA). Les indications chirurgicales et interventionnelles se sont élargies et nous opérons aujourd'hui à des stades précoces voire asymptomatiques. Une réintervention chirurgicale valvulaire est nécessaire dans environ 15% des cas au cours de l'évolution d'une valvulopathie opérée. L'objectif de notre étude est de déterminer la fréquence des réinterventions valvulaires et d'identifier les principales indications de ces réinterventions. Méthodes - Il s'agit d'une étude rétrospective descriptive, portant sur 45 patients, admis au service de cardiologie du Centre Hospitalo-Universitaire (CHU) d'Oran, de janvier 2011 à juillet 2013, et présentant une valvulopathie déjà opérée nécessitant une autre réintervention chirurgicale valvulaire. Résultats - La moyenne d'âge est de 41 ans, 73% des patients sont des femmes et 27% des hommes (Sex ratio de 0,37). La plupart de nos patients sont symptomatiques (dyspnée stade II de la NYHA). Les réinterventions intéressent la valve mitrale dans 69% des cas, la valve aortique dans 37% des cas et la valve tricuspide dans 35%. Nous avons constaté l'importance des insuffisances aortiques et tricuspides négligées lors de la première intervention (31% et 62% respectivement). Le délai moyen entre les deux interventions, tout type confondu, est de 21 ans. Conclusion - Les réinterventions cardiaques peuvent survenir au cours de l'évolution d'une valvulopathie. Une bonne évaluation cardiaque initiale des valvulopathies lors d'une chirurgie portant sur la valve mitrale ou aortique est indispensable pour pallier au problème d'une réintervention pour des valvulopathies négligées.

Background - Valvular heart disease still common despite improved health conditions that have reduced the rheumatic fever incidence. Surgical and interventional indications have expanded and today we operate at early stages, sometimes even an asymptomatic stage. Valvular reoperation is required in 15% of cases during the evolution of an operated valve disease. The aim of our study is to determine the frequency of valvular reoperations and identify the main indications of these reinterventions. Methods - This is a retrospective study included 45 patients who were admitted to the cardiology department of University Hospital center of Oran, from January 2011 to July 2013 and who had previously operated valvular disease requiring another surgical valvular reoperation. Results - The mean age is 41 years. 73% of patients are women and 27% are men. 95% of patients are symptomatic (NYHA dyspnea stage II). Reinterventions affected the mitral valve in 69% of cases, the aortic valve in 37% cases and the tricuspid valve in 35%. We reporte the importance of neglected aortic and tricuspid regurgitation during the first intervention (31% and 62% respectively). The average time between the two interventions, all types combined, is 21 years. Conclusion - Cardiac reoperations may occur during the course of valvular heart disease. A good initial cardiac evaluation before surgery on the mitral or aortic valve is essential to overcome the problem of neglected valvular disease reoperation.