HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thomas Walther Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Walther, T. Articles by Walther, C. Search for Related Content PubMed PubMed Citation Articles by Walther, T. Articles by Walther, C. Related Collections Valve disease Related Article

---

Original Articles: Adult Cardiac

Invited Commentary

^a Department of Cardiac Surgery, University Leipzig, Heartcenter, Strümpellstrasse 39, Leipzig, D-04289 Germany
^b Department of Cardiology, University Leipzig, Heartcenter, Strümpellstrasse 39, Leipzig, D-04289 Germany

(Email: walt{at}medizin.uni-leipzig.de).

Valve-in-a-valve (VinV) implantation is a valid therapeutic option to treat patients with diseased xenografts who are at high risk for conventional redo cardiac surgery. The VinV implantation has been performed in individual patients using antegrade transapical or retrograde transfemoral approaches with the Edwards Sapien (Edwards Lifesciences, Irvine, CA) or CoreValve (Irvine, CA) prostheses at different centers. The indications for VinV implantation should be made according to published position statements [1].

Azadani and colleagues [2] are presenting experimental data on using a newly developed transcatheter valve design for VinV implantations. They specifically created a supravalvular transcatheter valve (30 mm in length) using a Dacron-covered stainless steel stent (DuPont, Wilmington, DE) at the base of an open stent in the upper part, which is housing pericardial valve leaflets [2]. This is an interesting concept to obtain good hemodynamic function, especially in the presence of small degenerated conventional xenografts.

Clinical practice, however, may be slightly different; the VinV implantation using the commercially available Edwards Sapien device (Edwards Lifesciences) has led to excellent and durable clinical results so far [3]. The Sapien prosthesis matches very nicely within conventional xenografts, and VinV implantation allows for stable positioning when using some crowning of the stent. Hemodynamic function due to the low profile of the Sapien stent is acceptably good and compares well with conventional xenograft function. We did not observe any relevant incompetence in our patients treated clinically thus far. The use of longer stents (in contradiction) may interfere with the human anatomy; after conventional aortic valve implantation the sewing of the xenograft is located a few mm below the coronary arteries only, and the struts may get close to the sinotubular junction. Therefore, before VinV implantation for optimal imaging and to avoid any coronary obstruction, computed tomographic measurements of the aortic sinuses are mandatory. In patients with narrow aortic roots and small xenografts who are at risk for patient prosthesis mismatch, however, conventional redo surgery with root replacement may be the therapeutic option to choose.

In summary, the authors have contributed an interesting concept to improve hemodynamic function after VinV implantations. The clinical feasibility, however, remains to be proven. Overall, VinV implantation is an exiting field that offers minimally invasive therapy for high-risk elderly patients with xenograft dysfunction.

Dr Thomas Walther discloses that he has a financial relationship with Edwards Lifesciences.

 

	References

Top References

 

1. Vahanian A, Alfieri O, Al-Attar N, et al. European Association of Cardio-Thoracic SurgeryEuropean Society of CardiologyEuropean Association of Percutaneous Cardiovascular Interventions Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Eur Heart J 2008;11:1463-1470.
2. Azadani AN, Jaussaud N, Matthews PB, et al. Valve-in-valve implantation using a novel supravalvular transcatheter aortic valve: proof of concept Ann Thorac Surg 2009;88:1864-1870.[Abstract/Free Full Text]
3. Walther T, Kempfert J, Borger MA, et al. Human minimally invasive off-pump Valve-in-a-valve implantation Ann Thorac Surg 2008;85:1072-1073.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thomas Walther Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Walther, T. Articles by Walther, C. Search for Related Content PubMed PubMed Citation Articles by Walther, T. Articles by Walther, C. Related Collections Valve disease Related Article