- Email: [email protected]
Valve-in-Valve Transcatheter Aortic Valve Replacements: To TEE or not to TEE?
Journal of Cardiothoracic and Vascular Anesthesia ] (]]]]) ]]]–]]]
Contents lists available at ScienceDirect
HOSTED BY
journal homepage: www.jcvaonline.com
Case Report
Valve-in-Valve Transcatheter Aortic Valve Replacements: To TEE or not to TEE? n 1
n
Swapnil Khoche, MBBS , , Justin Pollock, MD , Eugene Golts, MD
†
n
†
Department of Anesthesiology, University of California, San Diego, CA Department of Cardiac Surgery, University of California, San Diego, CA
Key Words: valve-in-valve TAVR; transcatheter aortic valve replacement; transthoracic echocardiography; paravalvular regurgitation; aortic stenosis; aortic insufficiency; transesophageal echocardiography
RECENT ADVANCES IN transcatheter aortic valve replacement (TAVR) have shown the procedure to be a viable alternative in patients requiring repeat aortic valve replacement (AVR); however, clinical experience with this technique still is somewhat limited compared with TAVRs in native valves. In 2014, the Valve-in-Valve International Data (VIVID) Registry evaluated 459 patients, who underwent valve-in-valve (ViV) TAVR implantation from 2007 to 2013, and showed an 83.2% overall survival at 1-year postprocedure.1 Appropriate patient selection is crucial for a successful ViV TAVR procedure. An important consideration is the presence of paravalvular regurgitation (PVR), which fortunately is relatively rare after surgical prosthetic aortic valve implantation. PVR generally is a consequence of suture dehiscence, and rates of PVR 1-to-3 years after AVR have been reported to be as high as 10% to 48%, although most of these leaks were small and not clinically significant.2,3 The presence of PVR essentially precludes a ViV TAVR and thus should not be missed in the workup.
Case Report A 79-year-old, 162-cm, 66-kg male with a history of 5-vessel coronary artery bypass grafts, ischemic cardiomyopathy 1 Address reprint requests to Swapnil Khoche, MBBS, Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of California, San Diego, Thornton Hospital, 9444 Campus Point Drive #7651, La Jolla, CA 92093. E-mail address: [email protected] (S. Khoche).
(ejection fraction 37%), and bioprosthetic AVR for aortic stenosis 13 years prior was scheduled for a transfemoral ViV TAVR for severe bioprosthetic aortic insufficiency (AI). He was admitted to the hospital approximately 1 week prior with symptoms of acute decompensated congestive heart failure associated with severe AI. He had experienced worsening dyspnea and fatigue for the past year, with multiple admissions to an outside hospital for volume overload and acute heart failure. Transthoracic echocardiography (TTE) confirmed the cardiomyopathy and severe AI, with additional moderate mitral regurgitation, moderate pulmonary hypertension, and severe diastolic dysfunction (Fig 1; Videos 1 and 2). Left-heart catheterization revealed widely patent coronary artery bypass grafts. A preoperative coronary computed tomography scan yielded an annular measurement of 25 mm for the aortic valve but did not yield new information regarding the patient’s AI. Patient refusal (related to claustrophobia) precluded cardiac magnetic resonance imaging without general anesthesia. A TAVR technique was preferred for valve replacement due to the patient’s frailty, patent coronary grafts, and previous sternotomy. The calculated Society of Thoracic Surgeons risk for morbidity and mortality for this patient was about 65% and 20%, respectively, thus justifying the TAVR procedure.4 Other pertinent medical history included rheumatoid arthritis, managed with prednisone and hydroxychloroquine, and benign prostatic hyperplasia. After placement of a preoperative radial arterial catheter, the patient underwent a stable intravenous induction of anesthesia with propofol, fentanyl, diphenhydramine, and rocuronium, followed by endotracheal intubation. Postinduction, a transesophageal
http://dx.doi.org/10.1053/j.jvca.2017.03.031 1053-0770/& 2017 Elsevier Inc. All rights reserved.
Please cite this article as: Khoche S, et al. (2017), http://dx.doi.org/10.1053/j.jvca.2017.03.031
2
S. Khoche et al. / Journal of Cardiothoracic and Vascular Anesthesia ] (]]]]) ]]]–]]]
discharged home 3 days postprocedure. He eventually was readmitted to the hospital for percutaneous management of the paravalvular leak. He underwent deployment of two 8-mm and one 6-mm Amplatzer devices (St. Jude Medical, St. Paul, MN) in the transannular paravalvular location, with reduction in the severity of his AI. This procedure was complicated by a periprocedural stroke, which left him with left-sided hemiparesis. He had a significant degree of neurologic recovery at the time of hospital discharge, which occurred on postprocedural day 7. Discussion
Fig 1. Zoomed-in transthoracic echocardiography screen shot of the prosthetic aortic valve in short axis with color-flow Doppler. It is very difficult to discern the transvalvular versus perivalvular nature of the regurgitant jet.
echocardiography (TEE) probe was placed, followed by a right internal jugular 9-Fr introducer and 6-Fr sheath (to accommodate a transvenous pacing lead). The initial TEE examination demonstrated a reduced ejection fraction of 45%, mild mitral and tricuspid valve regurgitation, and severe AI, as reported (Fig 2). However, the leak appeared to be paravalvular and was suspected to lie outside the perimeter of the noncoronary cusp (Fig 3, Video 3). The bioprosthetic aortic valve itself appeared to be competent without any significant transvalvular regurgitation and with adequate movement of the leaflets and no rocking of the sewing ring. Three-dimensional (3D) color-Doppler imaging of the valve confirmed the paravalvular nature of the regurgitation and a wrap-around nature of its trajectory (Fig 4; Video 4). The discovery of the regurgitation being paravalvular, instead of transvalvular, prompted a discussion among the surgical team and led to a mutual decision to abort the TAVR procedure. The patient’s airway was extubated uneventfully, and the patient was
Recent trends in AVR have resulted in a shift toward bioprosthetic valve implantation over mechanical valves.1 Bioprosthetic aortic valves offer patients the benefit of not requiring lifelong systemic anticoagulation at the expense of valve durability. Reports vary in the literature, but in a retrospective, cohort analysis of 4,200 patients post-AVR, the 15-year cumulative incidence of redo surgery was 12.1% in the bioprosthetic AVR group versus 6.9% in the mechanical aortic valve group.5 Open surgical valve replacement after prosthetic aortic valve failure still is considered the standard of care; however, redo surgery generally carries significant morbidity because these patients tend to be elderly and in some degree of cardiac decompensation. After initial reports emerged of its viability in 2007, ViV TAVR has become a less-invasive alternative to surgical AVR in failed bioprostheses in certain patients. Patients undergoing ViV TAVRs comprise a high-risk population, with a reported postprocedure 30day mortality rate of 7.6%.1 These patients can present with valve stenosis, regurgitation, or both. Clinically significant regurgitation can be present in more than two-thirds of the patients,6,7 who then must undergo additional procedures to determine the site, character, and severity of regurgitation. PVR, which commonly occurs secondary to valve dehiscence, is not expected to improve with a TAVR procedure.
Fig 2. Color-flow Doppler M-mode of the left ventricular outflow tract. Diastolic aortic valve regurgitant flow takes up more than 65% of the diameter of the left ventricular outflow tract, consistent with severe aortic insufficiency. Please cite this article as: Khoche S, et al. (2017), http://dx.doi.org/10.1053/j.jvca.2017.03.031
S. Khoche et al. / Journal of Cardiothoracic and Vascular Anesthesia ] (]]]]) ]]]–]]]
3
Fig 3. Zoomed-in transesophageal screen shot of the prosthetic aortic valve in short and long axis with color-flow Doppler. The aortic regurgitant jet appeared to be perivalvular.
Reliable imaging of PVR can be challenging. TTE carries the disadvantages of operator dependency, acoustic shadowing from the prosthetic material, and poor windows in patients with obesity and chronic obstructive pulmonary disease.2,8 With improving technology, the sensitivity of TEE is considered to be higher in the detection of structural changes in prosthetic aortic valves.3,9 TEE evaluation of a prosthesis in the aortic position is more challenging than one in the mitral position due to artifacts from the sewing ring and a probe orientation that is nearly parallel to the plane of the
valve.9 Specifically in the setting of TAVRs, there is significant variability in the incidence of reported paravalvular AI after valve deployment. Inconsistency in paravalvular AI diagnosis comes from differences in imaging techniques, timing of assessment, and lack of a standardized classification system.8 This difficulty in elucidating the nature, character, and intensity is applicable to assessment of surgical paravalvular AI as well, and any benefit that TEE can provide should be welcomed. The patient described here underwent multiple diagnostic imaging studies and still made it to
Fig 4. Screen shot of 3D multiplanar reconstruction of the aortic valve with color-flow Doppler. The regurgitant jet clearly can be visualized as perivalvular. Please cite this article as: Khoche S, et al. (2017), http://dx.doi.org/10.1053/j.jvca.2017.03.031
4
S. Khoche et al. / Journal of Cardiothoracic and Vascular Anesthesia ] (]]]]) ]]]–]]]
the operating room with a misdiagnosis that ultimately was clarified using TEE, thus saving him a procedure that would have been unhelpful. Although echocardiography remains an essential part of patient evaluation for ViV TAVRs, a clear recommendation for whether it should be TEE or TTE is not forthcoming from most authors.10–12 In a recent study, TEE and TTE were viewed interchangeably as diagnostic modalities for evaluating native aortic stenosis as part of an overall approach to minimizing invasive preoperative tests before TAVRs.13 The notable exception is from the authors of the VIVID registry, who have recommended that all candidates for ViV TAVRs should undergo TEE evaluation.1 Routine use of screening TEE may have prevented the patient described here from undergoing a somewhat unnecessary and potentially risky anesthetic procedure. The benefit of TEE is especially important to consider in light of an increase in the rate of TAVRs performed with the patient under sedation. Because sedation generally precludes the use of TEE, it is possible that significant PVR could be missed in ViV TAVR candidates if a screening TEE is not performed.14 The role of 3D TEE in the evaluation of PVR is still evolving. Dvir et al did not comment on the utility of 3D TEE in this subpopulation (as part of their report on the data from the VIVID registry).1 The authors of the case report presented here concur with Camboni et al in seeing benefit in routine 3D reconstruction imaging (using TEE) to evaluate prospective candidates for ViV TAVR.7 In the case presented here, in addition to confirming the paravalvular nature of the aortic valve regurgitation, 3D datasets obtained intraoperatively were extremely useful for planning the future device closure of the paravalvular leak. To summarize, patients for ViV TAVRs can present with inadvertent PVR, which may prove to be notoriously difficult to both diagnose and quantify, particularly with TTE. Efforts to minimize diagnostic and surgical burden on this frail population should not lightly dismiss the benefit of preoperative TEE evaluation because it can provide valuable guidance in managing these challenging cases. Appendix A. Supplementary material Supplementary data are available in the online version of this article at http://dx.doi.org/10.1053/j.jvca.2017.03.031
References 1 Dvir D, Webb JG, Bleiziffer S, et al. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. JAMA 2014;312:162–70. 2 Hahn RT, Pibarot P, Stewart WJ, et al. Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: A longitudinal study of echocardiography parameters in cohort A of the PARTNER Trial (Placement of Aortic Transcatheter Valves). J Am Coll Cardiol 2013;61:2514–21. 3 Ionescu A, Fraser AG, Butchart EG. Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: A prospective study using transoesophageal echocardiography. Heart 2003;89:1316–21. 4 O’Brien SM, Shahian DM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: Part 2—Isolated valve surgery. Ann Thorac Surg 2009;88(Suppl):S23–42. 5 Chiang YP, Chikwe J, Moskowitz AJ. Survival and long-term outcomes following bioprosthetic vs mechanical aortic valve replacement in patients aged 50 to 69 years. JAMA 2014;312:1323–9. 6 Suri RM, Webb J, Mack M, et al. TCT-688 one year results of transcatheter aortic valve therapy for failed surgical bioprostheses PARTNER II Valve-in-Valve Registry. J Am Coll Cardiol 2014;64:B201. 7 Camboni D, Holzamer A, Flörchinger B, et al. Single institution experience with transcatheter valve-in-valve implantation emphasizing strategies for coronary protection. Ann Thorac Surg 2015;99:1532–8. 8 Ribeiro HB, Le Ven F, Larose E, et al. Cardiac magnetic resonance versus transthoracic echocardiography for the assessment and quantification of aortic regurgitation in patients undergoing transcatheter aortic valve implantation. Heart 2014;100:1924–32. 9 Daniel WG, Mügge A, Grote J, et al. Comparison of transthoracic and transesophageal echocardiography for detection of abnormalities of prosthetic and bioprosthetic valves in the mitral and aortic positions. Am J Cardiol 1993;71:210–5. 10 Piazza N, Bleiziffer S, Brockmann G, et al. Transcatheter aortic valve implantation for failing surgical aortic bioprosthetic valve: From concept to clinical application and evaluation (part 2). JACC Cardiovasc Interv 2011;4:733–42. 11 Gallo M, Dvir D, Demertzis S, et al. Transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic and mitral valves. Expert Rev Med Devices 2016;13:749–58. 12 Seiffert M, Franzen O, Conradi L, et al. Series of transcatheter valve-invalve implantations in high-risk patients with degenerated bioprostheses in aortic and mitral position. Catheter Cardiovasc Interv 2010;76:608–15. 13 Chieffo A, Giustino G, Spagnolo P, et al. Routine screening of coronary artery disease with computed tomographic coronary angiography in place of invasive coronary angiography in patients undergoing transcatheter aortic valve replacement. Circ Cardiovasc Interv 2015;8:e002025. 14 Babaliaros V, Devireddy C, Lerakis S, et al. Comparison of transfemoral transcatheter aortic valve replacement performed in the catheterization laboratory (minimalist approach) versus hybrid operating room (standard approach): Outcomes and cost analysis. JACC Cardiovasc Interv 2014;7: 898–904.
Please cite this article as: Khoche S, et al. (2017), http://dx.doi.org/10.1053/j.jvca.2017.03.031
Contents lists available at ScienceDirect
HOSTED BY
journal homepage: www.jcvaonline.com
Case Report
Valve-in-Valve Transcatheter Aortic Valve Replacements: To TEE or not to TEE? n 1
n
Swapnil Khoche, MBBS , , Justin Pollock, MD , Eugene Golts, MD
†
n
†
Department of Anesthesiology, University of California, San Diego, CA Department of Cardiac Surgery, University of California, San Diego, CA
Key Words: valve-in-valve TAVR; transcatheter aortic valve replacement; transthoracic echocardiography; paravalvular regurgitation; aortic stenosis; aortic insufficiency; transesophageal echocardiography
RECENT ADVANCES IN transcatheter aortic valve replacement (TAVR) have shown the procedure to be a viable alternative in patients requiring repeat aortic valve replacement (AVR); however, clinical experience with this technique still is somewhat limited compared with TAVRs in native valves. In 2014, the Valve-in-Valve International Data (VIVID) Registry evaluated 459 patients, who underwent valve-in-valve (ViV) TAVR implantation from 2007 to 2013, and showed an 83.2% overall survival at 1-year postprocedure.1 Appropriate patient selection is crucial for a successful ViV TAVR procedure. An important consideration is the presence of paravalvular regurgitation (PVR), which fortunately is relatively rare after surgical prosthetic aortic valve implantation. PVR generally is a consequence of suture dehiscence, and rates of PVR 1-to-3 years after AVR have been reported to be as high as 10% to 48%, although most of these leaks were small and not clinically significant.2,3 The presence of PVR essentially precludes a ViV TAVR and thus should not be missed in the workup.
Case Report A 79-year-old, 162-cm, 66-kg male with a history of 5-vessel coronary artery bypass grafts, ischemic cardiomyopathy 1 Address reprint requests to Swapnil Khoche, MBBS, Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of California, San Diego, Thornton Hospital, 9444 Campus Point Drive #7651, La Jolla, CA 92093. E-mail address: [email protected] (S. Khoche).
(ejection fraction 37%), and bioprosthetic AVR for aortic stenosis 13 years prior was scheduled for a transfemoral ViV TAVR for severe bioprosthetic aortic insufficiency (AI). He was admitted to the hospital approximately 1 week prior with symptoms of acute decompensated congestive heart failure associated with severe AI. He had experienced worsening dyspnea and fatigue for the past year, with multiple admissions to an outside hospital for volume overload and acute heart failure. Transthoracic echocardiography (TTE) confirmed the cardiomyopathy and severe AI, with additional moderate mitral regurgitation, moderate pulmonary hypertension, and severe diastolic dysfunction (Fig 1; Videos 1 and 2). Left-heart catheterization revealed widely patent coronary artery bypass grafts. A preoperative coronary computed tomography scan yielded an annular measurement of 25 mm for the aortic valve but did not yield new information regarding the patient’s AI. Patient refusal (related to claustrophobia) precluded cardiac magnetic resonance imaging without general anesthesia. A TAVR technique was preferred for valve replacement due to the patient’s frailty, patent coronary grafts, and previous sternotomy. The calculated Society of Thoracic Surgeons risk for morbidity and mortality for this patient was about 65% and 20%, respectively, thus justifying the TAVR procedure.4 Other pertinent medical history included rheumatoid arthritis, managed with prednisone and hydroxychloroquine, and benign prostatic hyperplasia. After placement of a preoperative radial arterial catheter, the patient underwent a stable intravenous induction of anesthesia with propofol, fentanyl, diphenhydramine, and rocuronium, followed by endotracheal intubation. Postinduction, a transesophageal
http://dx.doi.org/10.1053/j.jvca.2017.03.031 1053-0770/& 2017 Elsevier Inc. All rights reserved.
Please cite this article as: Khoche S, et al. (2017), http://dx.doi.org/10.1053/j.jvca.2017.03.031
2
S. Khoche et al. / Journal of Cardiothoracic and Vascular Anesthesia ] (]]]]) ]]]–]]]
discharged home 3 days postprocedure. He eventually was readmitted to the hospital for percutaneous management of the paravalvular leak. He underwent deployment of two 8-mm and one 6-mm Amplatzer devices (St. Jude Medical, St. Paul, MN) in the transannular paravalvular location, with reduction in the severity of his AI. This procedure was complicated by a periprocedural stroke, which left him with left-sided hemiparesis. He had a significant degree of neurologic recovery at the time of hospital discharge, which occurred on postprocedural day 7. Discussion
Fig 1. Zoomed-in transthoracic echocardiography screen shot of the prosthetic aortic valve in short axis with color-flow Doppler. It is very difficult to discern the transvalvular versus perivalvular nature of the regurgitant jet.
echocardiography (TEE) probe was placed, followed by a right internal jugular 9-Fr introducer and 6-Fr sheath (to accommodate a transvenous pacing lead). The initial TEE examination demonstrated a reduced ejection fraction of 45%, mild mitral and tricuspid valve regurgitation, and severe AI, as reported (Fig 2). However, the leak appeared to be paravalvular and was suspected to lie outside the perimeter of the noncoronary cusp (Fig 3, Video 3). The bioprosthetic aortic valve itself appeared to be competent without any significant transvalvular regurgitation and with adequate movement of the leaflets and no rocking of the sewing ring. Three-dimensional (3D) color-Doppler imaging of the valve confirmed the paravalvular nature of the regurgitation and a wrap-around nature of its trajectory (Fig 4; Video 4). The discovery of the regurgitation being paravalvular, instead of transvalvular, prompted a discussion among the surgical team and led to a mutual decision to abort the TAVR procedure. The patient’s airway was extubated uneventfully, and the patient was
Recent trends in AVR have resulted in a shift toward bioprosthetic valve implantation over mechanical valves.1 Bioprosthetic aortic valves offer patients the benefit of not requiring lifelong systemic anticoagulation at the expense of valve durability. Reports vary in the literature, but in a retrospective, cohort analysis of 4,200 patients post-AVR, the 15-year cumulative incidence of redo surgery was 12.1% in the bioprosthetic AVR group versus 6.9% in the mechanical aortic valve group.5 Open surgical valve replacement after prosthetic aortic valve failure still is considered the standard of care; however, redo surgery generally carries significant morbidity because these patients tend to be elderly and in some degree of cardiac decompensation. After initial reports emerged of its viability in 2007, ViV TAVR has become a less-invasive alternative to surgical AVR in failed bioprostheses in certain patients. Patients undergoing ViV TAVRs comprise a high-risk population, with a reported postprocedure 30day mortality rate of 7.6%.1 These patients can present with valve stenosis, regurgitation, or both. Clinically significant regurgitation can be present in more than two-thirds of the patients,6,7 who then must undergo additional procedures to determine the site, character, and severity of regurgitation. PVR, which commonly occurs secondary to valve dehiscence, is not expected to improve with a TAVR procedure.
Fig 2. Color-flow Doppler M-mode of the left ventricular outflow tract. Diastolic aortic valve regurgitant flow takes up more than 65% of the diameter of the left ventricular outflow tract, consistent with severe aortic insufficiency. Please cite this article as: Khoche S, et al. (2017), http://dx.doi.org/10.1053/j.jvca.2017.03.031
S. Khoche et al. / Journal of Cardiothoracic and Vascular Anesthesia ] (]]]]) ]]]–]]]
3
Fig 3. Zoomed-in transesophageal screen shot of the prosthetic aortic valve in short and long axis with color-flow Doppler. The aortic regurgitant jet appeared to be perivalvular.
Reliable imaging of PVR can be challenging. TTE carries the disadvantages of operator dependency, acoustic shadowing from the prosthetic material, and poor windows in patients with obesity and chronic obstructive pulmonary disease.2,8 With improving technology, the sensitivity of TEE is considered to be higher in the detection of structural changes in prosthetic aortic valves.3,9 TEE evaluation of a prosthesis in the aortic position is more challenging than one in the mitral position due to artifacts from the sewing ring and a probe orientation that is nearly parallel to the plane of the
valve.9 Specifically in the setting of TAVRs, there is significant variability in the incidence of reported paravalvular AI after valve deployment. Inconsistency in paravalvular AI diagnosis comes from differences in imaging techniques, timing of assessment, and lack of a standardized classification system.8 This difficulty in elucidating the nature, character, and intensity is applicable to assessment of surgical paravalvular AI as well, and any benefit that TEE can provide should be welcomed. The patient described here underwent multiple diagnostic imaging studies and still made it to
Fig 4. Screen shot of 3D multiplanar reconstruction of the aortic valve with color-flow Doppler. The regurgitant jet clearly can be visualized as perivalvular. Please cite this article as: Khoche S, et al. (2017), http://dx.doi.org/10.1053/j.jvca.2017.03.031
4
S. Khoche et al. / Journal of Cardiothoracic and Vascular Anesthesia ] (]]]]) ]]]–]]]
the operating room with a misdiagnosis that ultimately was clarified using TEE, thus saving him a procedure that would have been unhelpful. Although echocardiography remains an essential part of patient evaluation for ViV TAVRs, a clear recommendation for whether it should be TEE or TTE is not forthcoming from most authors.10–12 In a recent study, TEE and TTE were viewed interchangeably as diagnostic modalities for evaluating native aortic stenosis as part of an overall approach to minimizing invasive preoperative tests before TAVRs.13 The notable exception is from the authors of the VIVID registry, who have recommended that all candidates for ViV TAVRs should undergo TEE evaluation.1 Routine use of screening TEE may have prevented the patient described here from undergoing a somewhat unnecessary and potentially risky anesthetic procedure. The benefit of TEE is especially important to consider in light of an increase in the rate of TAVRs performed with the patient under sedation. Because sedation generally precludes the use of TEE, it is possible that significant PVR could be missed in ViV TAVR candidates if a screening TEE is not performed.14 The role of 3D TEE in the evaluation of PVR is still evolving. Dvir et al did not comment on the utility of 3D TEE in this subpopulation (as part of their report on the data from the VIVID registry).1 The authors of the case report presented here concur with Camboni et al in seeing benefit in routine 3D reconstruction imaging (using TEE) to evaluate prospective candidates for ViV TAVR.7 In the case presented here, in addition to confirming the paravalvular nature of the aortic valve regurgitation, 3D datasets obtained intraoperatively were extremely useful for planning the future device closure of the paravalvular leak. To summarize, patients for ViV TAVRs can present with inadvertent PVR, which may prove to be notoriously difficult to both diagnose and quantify, particularly with TTE. Efforts to minimize diagnostic and surgical burden on this frail population should not lightly dismiss the benefit of preoperative TEE evaluation because it can provide valuable guidance in managing these challenging cases. Appendix A. Supplementary material Supplementary data are available in the online version of this article at http://dx.doi.org/10.1053/j.jvca.2017.03.031
References 1 Dvir D, Webb JG, Bleiziffer S, et al. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. JAMA 2014;312:162–70. 2 Hahn RT, Pibarot P, Stewart WJ, et al. Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: A longitudinal study of echocardiography parameters in cohort A of the PARTNER Trial (Placement of Aortic Transcatheter Valves). J Am Coll Cardiol 2013;61:2514–21. 3 Ionescu A, Fraser AG, Butchart EG. Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: A prospective study using transoesophageal echocardiography. Heart 2003;89:1316–21. 4 O’Brien SM, Shahian DM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: Part 2—Isolated valve surgery. Ann Thorac Surg 2009;88(Suppl):S23–42. 5 Chiang YP, Chikwe J, Moskowitz AJ. Survival and long-term outcomes following bioprosthetic vs mechanical aortic valve replacement in patients aged 50 to 69 years. JAMA 2014;312:1323–9. 6 Suri RM, Webb J, Mack M, et al. TCT-688 one year results of transcatheter aortic valve therapy for failed surgical bioprostheses PARTNER II Valve-in-Valve Registry. J Am Coll Cardiol 2014;64:B201. 7 Camboni D, Holzamer A, Flörchinger B, et al. Single institution experience with transcatheter valve-in-valve implantation emphasizing strategies for coronary protection. Ann Thorac Surg 2015;99:1532–8. 8 Ribeiro HB, Le Ven F, Larose E, et al. Cardiac magnetic resonance versus transthoracic echocardiography for the assessment and quantification of aortic regurgitation in patients undergoing transcatheter aortic valve implantation. Heart 2014;100:1924–32. 9 Daniel WG, Mügge A, Grote J, et al. Comparison of transthoracic and transesophageal echocardiography for detection of abnormalities of prosthetic and bioprosthetic valves in the mitral and aortic positions. Am J Cardiol 1993;71:210–5. 10 Piazza N, Bleiziffer S, Brockmann G, et al. Transcatheter aortic valve implantation for failing surgical aortic bioprosthetic valve: From concept to clinical application and evaluation (part 2). JACC Cardiovasc Interv 2011;4:733–42. 11 Gallo M, Dvir D, Demertzis S, et al. Transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic and mitral valves. Expert Rev Med Devices 2016;13:749–58. 12 Seiffert M, Franzen O, Conradi L, et al. Series of transcatheter valve-invalve implantations in high-risk patients with degenerated bioprostheses in aortic and mitral position. Catheter Cardiovasc Interv 2010;76:608–15. 13 Chieffo A, Giustino G, Spagnolo P, et al. Routine screening of coronary artery disease with computed tomographic coronary angiography in place of invasive coronary angiography in patients undergoing transcatheter aortic valve replacement. Circ Cardiovasc Interv 2015;8:e002025. 14 Babaliaros V, Devireddy C, Lerakis S, et al. Comparison of transfemoral transcatheter aortic valve replacement performed in the catheterization laboratory (minimalist approach) versus hybrid operating room (standard approach): Outcomes and cost analysis. JACC Cardiovasc Interv 2014;7: 898–904.
Please cite this article as: Khoche S, et al. (2017), http://dx.doi.org/10.1053/j.jvca.2017.03.031