FIRST ITALIAN CASE OF TRANSCATHETER TREATMENT OF AORTIC REGURGITATION IN L–VAD PATIENT WITH A DEDICATED DEVICE

Abstract

Abstract In patients with L–VADs, aortic valve regurgitation is a relatively frequent complication often associated with high mortality. Surgical approaches are extremely complex and often lead to poor outcomes. TAVI can be a feasible solution but it is usually extremely challenging due to the absence of calcification and stenosis. We report the case of a 56–year–old man who underwent LVAD implantation 4years ago as destination therapy for dilated myocardiopathy and chronic multiple myeloma. During the last year, he progressively developed severe pure aortic regurgitation. Last month, he was admitted to our center for heart failure symptoms and recurrent ventricular arrhythmias (VT/VF). The patient was considered at high risk for surgery and evaluated for a transcatheter approach. Due to the absence of calcification and a relatively large annulus, we decided to use the JenaValve Trilogy prosthesis, the only THV CE approved for aortic regurgitation treatment. Unlike other types of THV (self– or balloon expandable), this is specifically designed for AR and does not require significant oversizing to allow correct anchoring. Another advantage in this setting is the possibility of avoiding the reduction of the LVAD flow due to the reduced risk of embolization and the possibility of proceeding to direct implantation without ventricular rapid pacing thanks to the direct anchoring method onto the native aortic leaflets. In this patient, a JenaValve size L bioprosthesis was implanted transfemorally under general anesthesia with an excellent result. The post–operative echocardiography showed a perfectly implanted prosthesis with no intraprosthesis regurgitation and only a mild anterior paravalvular leak with a subsequent improvement of all hemodynamic parameters. In our opinion, when feasible, the JenaValve implant can be a safe and effective therapeutic option in patients with active LVAD devices at high operative risk.