Abstract
BackgroundTranscatheter aortic valve implantation (TAVI) has proven to be a valid option for patients with severe aortic stenosis who are at high perioperative risk, particularly in patients with previous cardiac surgery. Several patients with previous mitral valve surgery were reported to have been successfully treated with TAVI.Case presentationTwo patients, one with mechanical and one with biological mitral valve prosthesis, presented with symptomatic severe aortic stenosis. After discussion among our multidisciplinary heart team transapical approach and a JenaValve™ prosthesis was used for TAVI. Main reasons were to decrease the perioperative risk, avoid a re-opening of the chest via median sternotomy, and discuss the possible superiority of the JenaValve™ device due to its design. The patients were successfully treated and discharged on the 11th and 14th post-operative day, respectively. Echocardiographic follow up before discharge and up to 2.8 years post-operatively showed excellent results.ConclusionsIn conclusion, TAVI in patients with preexisting mitral prostheses-mechanical or biological-is feasible, safe, and effective and offers a valid alternative to conventional aortic valve replacement in this particular re-operation scenario. The JenaValve™ device does not interact with the mitral prosthesis and offers therefore due to its unique design a potential advantage.
Highlights
Transcatheter aortic valve implantation (TAVI) has proven to be a valid option for patients with severe aortic stenosis who are at high perioperative risk, in patients with previous cardiac surgery
The JenaValveTM device does not interact with the mitral prosthesis and offers due to its unique design a potential advantage
The perioperative risk of morbidity and mortality is elevated in patients undergoing conventional aortic valve replacement with previous median sternotomy [3]
Summary
After a few reports about implanting JenaValveTM in patients with mechanical mitral valve prosthesis [9, 10], we report here a case of transcatheter aortic valve implantation using the self-expandable JenaValveTM in a patient with history of biological mitral valve prosthesis. Because the locators of the JenaValveTM are positioned into the nadir of the aortic valve sinus the lower margin does not reach more than 2 mm into the LVOT below the aortic annulus and offering a reasonable safe distance that is needed to prevent interference with the mitral valve prosthesis during deployment [9]. Our report and the previous experience with JenaValveTM [9, 10] suggest that the JenaValveTM prosthesis may offer a potential advantage over other prostheses, due to its design, when implanted in patients with previous mitral valve replacement. Abbreviations AS, aortic stenosis; AVR, aortic valve replacement; CABG, coronary artery bypass grafting; CTA, computed tomography angiography; EOA, effective orifice area; EuroSCORE, European System for Cardiac Operative Risk Evaluation; LVOT, left ventricular outflow tract; MVR, Mitral valve replacement; NYHA, New York Heart Association; POD, postoperative day; STS, Society of Thoracic Surgeons; TAVI, transcatheter aortic valve implantation
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