Transcatheter Implantation Research Articles

Leadless intracardiac transcatheter pacing system: 20 months follow up in adult Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is an X-linked muscular dystrophy in relation with dystrophin deficient. Heart and respiratory function are classically involved and affect long-term prognosis. Significant atrio-ventricular block may occur in some patients. Implantation of traditional pacemaker may be challenging in patients with tracheotomy and on permanent home mechanical ventilation. We report the first case of a successful leadless intra-cardiac trans-catheter pacing system implantation in an adult DMD on wheelchair and on permanent home mechanical ventilation.

Transcatheter Aortic Valve Replacement for Bicuspid Aortic Valve Stenosis: A Practical Operative Overview.

The bicuspid aortic valve (BAV) represents a complex anatomic scenario for transcatheter aortic valve replacement (TAVR) because of its unique technical challenges. As TAVR is moving towards younger and lower-risk populations, the proportion of BAV patients undergoing TAVR is expected to rise. Initial experiences of TAVR with first-generation transcatheter heart valves in high surgical risk patients with BAV stenosis showed higher rates of device failure and periprocedural complications as compared to tricuspid anatomy. The subsequent advances in imaging techniques and understanding of BAV anatomy, new iterations of transcatheter heart valves, and growing operators' experience yielded better outcomes. However, in the lack of randomized trials and rigorous evidence, the field of TAVR in BAV has been driven by empirical observations, with wide variability in transcatheter heart valve sizing and implantation techniques across different centers and operators. Thus, in this review article, we provide a fully illustrated overview of operative periprocedural steps for TAVR in BAV stenosis, though recognizing that it still remains anecdotal.

Percutaneous Mitral Valve Annuloplasty in Patients With Secondary Mitral Regurgitation and Severe Left Ventricular Enlargement

ObjectivesThis study sought to determine the effect of percutaneous mitral valve annuloplasty with the Carillon device versus guideline-directed medical therapy (GDMT) alone in patients with secondary mitral regurgitation (MR) and severe left ventricular (LV) enlargement. BackgroundThe clinical impact of the Carillon device in patients with severe LV dilation is not well established. MethodsThis is a pooled analysis involving 3 prospective trials (TITAN [Transcatheter Implantation of Carillon Mitral Annuloplasty Device], TITAN II, and REDUCE FMR [CARILLON Mitral Contour System for Reducing Functional Mitral Regurgitation] trials) in which patients with functional MR and severe LV enlargement (LV end-diastolic diameter >65 mm) were treated with GDMT and the Carillon device versus GDMT alone. Key outcomes of this analysis were changes over 1 year of follow-up in mitral valve and LV echocardiographic parameters, functional outcome, quality of life, mortality, and heart failure hospitalization (HFH). ResultsA total of 95 patients (67 in the Carillon group, 28 in the GDMT group) with severe LV enlargement were included. In the Carillon group, all mitral valve and LV morphology parameters were significantly improved at 1 year. Regurgitant volume decreased by 12 ml (p < 0.001), MR grade decreased by 0.6 U (p < 0.001), LV end-diastolic volume decreased by 25 cm3 (p = 0.005), and LV end-systolic volume decreased by 21 cm3 (p = 0.01). Significant functional improvement differences were also noted between the Carillon group and the GDMT group including an improvement of Kansas City Cardiomyopathy Questionnaire score (15 ± 4 vs. 6 ± 6; p = 0.03). The incidence of HFH was 29.9% versus 50.0% and the cumulative rate of HFH was 0.43 versus 0.75 (p < 0.001). ConclusionsIn patients with functional MR and severe LV enlargement, the Carillon device improved mitral valve function, LV morphology, and functional outcome compared with patients receiving GDMT only. Preoperative LV dimension should not be a limiting factor when evaluating patient eligibility or anticipated response to therapy with the Carillon device.

Aortic valve replacement vs. balloon-expandable and self-expandable transcatheter implantation: A network meta-analysis

IntroductionRecently, observational data have raised concerns about safety of selfexpandable (SE) compared to balloon-expandable (BE) valves in TAVI, although potentially limited by patient selection bias. Methods. All Randomized Controlled Trials (RCTs) comparing BE vs. SE TAVI or/and vs. aortic valve replacement (AVR) were included and compared through Network Meta Analysis (NMA). All-cause and cardiovascular (CV) mortality were the primary endpoints, stroke, rates of permanent pacemaker implantation (PPI), moderate/severe paravalvular leak (PVL) and reintervention were the secondary endpoints. Results We obtained data from 11 RCTs, encompassing 9752 patients. After one and two years, no significant differences for allcause and CV mortality were observed. Compared to surgical bioprostheses, both BE and SE TAVI reduced the risk of acute kidney injury (OR 0.42; CI 95% 0.30–0.60 and OR 0.44; CI 95% 0.32–0.60), new-onset atrial fibrillation (OR 0.24; CI 95% 0.14–0.42 and OR 0.21; CI 95% 0.13–0.34) and major bleedings (OR 0.32; CI 95% 0.16–0.65 and OR 0.47; CI 95% 0.25–0.89). The BE prostheses reduced the risk of moderate/severe PVL at 30-day (OR 0.31; CI 95% 0.17–0.55) and of PPI both at 30-day (OR 0.51; CI 95% 0.33–0.79) and 1 year (OR 0.40; CI 95% 0.30–0.55) as compared to SE TAVI. Conclusions A TAVI strategy, independently from BE or SE prostheses, offers a midterm survival comparable to AVR. The BE prostheses are associated with a reduction of PPI and PVL compared to SE prostheses without any differences in all-cause and CV mortality during two years of follow up. PROSPERO ID CRD42020182407.

Nit-Occlud atrial septal defect occluder device: Histological characterisation of the healing process.

We describe the healing process following transcatheter implantation of the Nit-Occlud ASD-R occluder (PFM medical, Cologne, Germany) for atrial septal defect closure in a sheep model with histological confirmation of neotissue formation covering the device.

Features of echocardiographic assessment on transcatheter aortic valve implantation multiple stages

The aim – to systematize information on key features of echocardiographic evaluation of transcatheter aortic valve implantation (TAVI) procedure stages and their effectiveness in cardiac surgery, in patients with severe aortic valve stenosis.Materials and methods. We initiated a single-center clinical study to evaluate the XPand device and initial analysis of the primary results was performed. Patients met the inclusion criteria underwent a full range of examinations and TAVI procedures using the XPand device. The key parameters for echocardiographic examination in TAVI, which influence the formation of further procedure strategy, have been determined for the cardiac surgeon.Results and discussion. Based on the determined echocardiographic parameters, we obtained the primary outcomes of TAVI XPand in patients (n=7), the result of implantation was good. Minimal paravalvular insufficiency absence was found in 71.5 % of patients and minimal insufficiency in 14,5 %. In one patient to moderate insufficiency was observed. There was a statistically significant improvement in the ejection fraction (p&lt;0.05) and a decrease in the mean gradient at the aortic valve (p&lt;0.01).Conclusions. Echocardiographic parameters at all TAVI stages in patients over 75 years allow to control the implementation of the procedure and to improve the immediate post procedural outcome. The first experience of using the novel device for transcatheter implantation of the XPand aortic valve prosthesis confirms its effectiveness and safety in elderly patients with severe aortic stenosis.

Imaging modalities in the planning of transcatheter aortic valve implantation (standardization of scanning, measurements and reporting protocols)

This review describes the state of the art on the role of various imaging modalities in pre-operative preparation to transcatheter implantation of biological aortic valve prosthesis, based on the literature data published from 2012 to 2020. One of the key source documents is the consensus of the European Society of Cardiovascular Radiology (ESCR) from 2019, providing the standardized protocols for scanning, measurements and description of the abnormalities identified. The final decision on the procedure of transcatheter aortic valve implantation should be based on the combination of all available diagnostic methods, clinical data and results of imaging by different modalities. Given the most comprehensive information content, the main diagnostic method is computed tomography. The radiologist and the multidisciplinary team should form a single entity, combining clinical and technical knowledge, discussing all the images and conclusions with other team members.

Use of the GORE�DrySeal Flex Introducer Sheath to Facilitate Implantation of the Transcatheter Venus P-valve

Objectives: We report our experience of using the 65 cm large diameter GORE® DrySeal Flex Introducer sheath to facilitate transcatheter implantation of the Venus P-valve in the pulmonary position. Background: Transcatheter implantation of pulmonary valves can be difficult due to rigidity of the valve delivery system or the anatomy of the RVOT and pulmonary artery bifurcation and the risk of iatrogenic damage to the tricuspid valve support apparatus. Using long sheaths to pass and protect the tricuspid valve may facilitate the procedure. Methods: Multi-centre registry of patients who underwent transcatheter pulmonary valve implantation of the Venus P-valve using the GORE® DrySeal Flex introducer sheath to facilitate passage of the valve to the right ventricular outflow tract. Procedural success, time to valve implantation and radiation safety parameters were analyzed. These data were compared to a control group of subjects treated between July 2014 and May 2016 with the same valve but without the use of GORE® DrySeal. Results: Between December 2016 and September 2018, the Venus P-valve was successfully deployed through the GORE® DrySeal in 12 patients. There were no procedure-related complications. As a control group, 10 subjects treated between July 2014 and May 2016 were included. Total procedure time was significantly shorter in the GORE® DrySeal group compared to the control group 96 ± 27 min vs. 164 ± 12 min (p < 0.001). Total screening time was significantly shorter in the GORE® DrySeal group (24 ± 11 min) when compared with the control group (32 ± 14 min, p < 0.001). Conclusions: We describe a modification to the previously described techniques of implanting the Venus P-valve in the pulmonary position after surgical repair of congenital heart disease. In our experience, the GORE® DrySeal sheath has considerably facilitated the procedure and reduced the potential risks.

First serial transcatheter implantation of pulmonary valve using MedLab-KT prosthesis

Surgical treatment of 'blue' congenital heart defects frequently implies various interventions on the outlet portion of the right ventricle or pulmonary artery trunk. Most often used are various conduits, reconstructing the outlet portion of the right ventricle and pulmonary artery. Most patients having previously endured the mentioned interventions, would in the remote terms require repeat operative procedures for stenosis or insufficiency on the pulmonary valve or the implanted conduit. Taking into account complexity and the risk of open interventions, the current trends are towards more frequent use of transcatheter implantation of the pulmonary valve. The purpose of this work is to present the first serial experience with hybrid transventricular implantation of an original Russian-made valve into the position of the pulmonary artery. We retrospectively studied a series of 5 clinical cases who from July 2019 to May 2020 at the Federal Centre of Cardiovascular Surgery (Penza) had underwent hybrid transventricular implantation of the first Russian-made valve-containing stent (MedLab-KT) into the position of the pulmonary valve, with the stent's closing component consisting of leaflets made of polytetrafluoroethylene. 3 patients underwent implantation of valve # 25 and 2 subjects received valve # 23, with all cases yielding good immediate results. The haemodynamic parameters of the implanted prosthesis were optimal. In all cases, the significant gradient was absent and regurgitation did not exceed grade I. There was no in-hospital mortality. The method of hybrid prosthetic repair of the pulmonary valve via the transapical right-ventricular access from the left lateral mini-thoracotomy was aimed at reducing potential risks of artificial circulation, also contributing to a significant decrease in the traumatic nature of surgical treatment of patients requiring a repeat intervention for pulmonary valve pathology.

Prognostic markers in patients undergoing transcatheter implantation of Venus P-valve: Experience in Taiwan

Prognostic factors remain unclear in patients undergoing transcatheter implantation of Venus P-valve for their severe pulmonary regurgitation associated with native right ventricular (RV) outflow tract. Between January 2017 and October 2018, we prospectively collected data of patient characteristics, cardiac magnetic resonance imaging, cardiopulmonary exercise testing, and levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) before and 6-12 months after valve graft implantation. Fifteen patients (male: 8, median age: 24.8 years) were enrolled. The procedure success rate was 100%. The median follow-up was 16.3 months without any dysfunction of the valve graft. The cohort demonstrated a significant improvement in cardiac index (from 3.3 to 3.9L/min/m2) and increase of percentage of New York Heart Association functional class I (P<10-3), reduction in RV end-diastolic volume index (P=0.008), and reductions in NT-proBNP levels (from 78.9 to 45.8pg/mL, P=0.040). However, the peak oxygen consumption (VO2) dropped from 50.2% to 48.5% of the predicted value. Interestingly, we determined that patients with NT-proBNP levels below 70pg/mL and left ventricular end-diastolic pressure (LVEDP) below 11mmHg had a significantly higher chance of exhibiting improvement in peak VO2 compared with those without (3/4 vs 1/10, P=0.041). In the small cohort with severe pulmonary regurgitation, implantation of a Venus P-valve led to promising reductions in RV volume. However, no definite improvement in cardiopulmonary exercise capacity or RV ejection fraction was achieved. Levels of NT-proBNP and LVEDP may be helpful for refining the indications of the Venus P-valve implantation.

Overcoming the transcatheter aortic valve replacement Achilles heel: conduction abnormalities-a systematic review.

Transcatheter aortic valve replacement (TAVR) has been shown to be a good alternative to surgery for treating severe symptomatic aortic stenosis (AS) across the whole range of surgical risk patients. Whereas most periprocedural TAVR complications have significantly decreased over time, conduction disturbances remain high. Approaches to decrease this shortcoming are under continuous investigation. We conducted a systematic review focusing on modifiable factors impacting post-TAVR conduction disturbances, such as balloon aortic valvuloplasty (BAV), type of new-generation transcatheter valve and implantation depth (ID). Search strategies were based on the best available evidence from each study. Primary endpoints were post-TAVR need of permanent pacemaker implantation (PPI) and new onset left bundle branch block (NOLBBB). Data from 35 studies with a total of 29,982 patients were analyzed. BAV did not negatively impact PPI rates after TAVR. In propensity-matched and randomized trials, the Evolut R valve was associated with higher rates of PPI compared to the Sapien 3 valve (25% vs. 19.2% in propensity-matched studies; 22.9% vs. 19% in a randomized trial). The Acurate Neo valve was associated with the lowest PPI rate in observational studies (10.4%), but a PPI rate similar to Sapien 3 was reported in a randomized trial (10% vs. 9%). The Portico valve system was associated with a higher PPI risk (PPI rate of 21.9% and 27.7% in propensity-matched and randomized studies, respectively). ID and its relation with the membranous septum (MS) length predicted post-TAVR conduction disturbances, particularly with Evolut R and Sapien 3 valves. Pre-TAVR BAV did not increase the risk of conduction disturbances post-TAVR. Among the new-generation transcatheter valve systems, Sapien 3 and Acurate Neo valves were associated with the lowest PPI rates followed by the Evolut and Portico valves. A deeper valve implantation and a shorter MS length determined an increased risk of conduction disturbances post-TAVR.

Valvular calcium load assessment for predicting postprocedural paravalvular leakage: a comparison between surgical aortic valve replacement versus transcatheter implantation

Abstract Background Calcification of native aortic valve is a well known variable causing paravalvular leakage (PVL) following transcatheter aortic valve implantation (TAVI). However, there is currently no evidence to support the fact that patients with high calcium load could be better treated with surgical aortic valve replacement (SAVR). Purpose To assess the utility of preoperative assessment of valvular calcium load through computed tomography in patients affected by severe aortic valve stenosis undergoing SAVR or TAVI. Methods Between June 2016 and June 2018, 109 candidates for isolated SAVR through minimal invasive access underwent preoperative contrast enhanced multidetector computed tomography (MDCT) for the assessment of valve and aortic calcifications. Calcium load was quantitatively measured using a dedicated software in three regions on interest (aortic valve [AV], left ventricular outflow tract [LVOT] and device landing zone [DLZ], which is the sum of the earlier 2). Clinical, echocardiographic, and MDCT variables were collected and compared to a sample population of 107 patients that underwent TAVI (87 transfemoral, 20 transapical) for native aortic valve stenosis in the same period of time, in the same institution. A univariate and multivariate logistic regression analysis were performed on the whole study population to assess risk factors for the onset of postoperative PVL (any grade, defined as ≥ mild) at discharge. Results The two study groups were significantly different in terms of age (71.9±5 in SAVR; 81.5±6 in TAVI), gender (36% female in SAVR vs 51% in TAVI), Euroscore II (1.9%±0.8 in SAVR; 4.8%±2.7 in TAVI), annulus perimeter (79.5mm±8.2 in SAVR; 61.8mm±30.5 in TAVI), baseline ejection fraction (57%±8 in SAVR; 51%±12 in TAVI) and severe pulmonary hypertension (2%±13 in SAVR; 26%±44 in TAVI). Calcium load was not different between groups (DLZ 1066 mm3±716 vs 955mm3±639; total calcium in AV 987 mm3±678 vs 879 mm3±601; total calcium in LVOT 78 mm3±130 vs 77 mm3±100). 30-days-mortality was 1.8% in SAVR and 5.6% in TAVI group (p=0.17). At discharge, incidence of all grades PVL was 5.5% in SAVR (0.9% trace, 3.6% mild, 0.9% moderate) and 41% in TAVI group (12.1% trace, 25.2% mild, 3.7% moderate) (p&amp;lt;0.05). On logistic regression on the whole study population, DLZ calcium (OR 1.1, 95% CI 1–1.2 for 100 mm3, p=0.003) and the use of TAVI (OR 24, 95% CI 7.7–78, p&amp;lt;0.001) were identified as independently associated with the onset of PVL. Conclusions Aortic valve calcifications are a risk factor for the onset of PVL for both TAVI and SAVR. Nevertheless, the risk increases considerably with the use of TAVI. A deeper anatomical analysis of preoperative MDCT could improve the treatment selection and the outcome of patients affected by aortic valve stenosis. Funding Acknowledgement Type of funding source: None

Valve-in-valve transcatheter aortic valve replacement on a self-expandable nitinol frame due to degeneration of primary bioprosthetic valve cusps. Clinical case of a high-risk surgical female patient

Introduction. We present the clinical observation of a 72-year-old female patient with high surgical risk and structural degeneration of a bioprosthetic aortic valve (AV) cusps in the form of stenosis, accompanied by severe dysfunction. Transcatheter implantation of bioprosthesis Medtronic CoreValve™ Evolut™ R-23 was performed using the valve-in-valve technique. The choice of minimally invasive treatment tactics is substantiated, a preoperative examination algorithm and a specific bioprosthesis model for such intervention are provided. Materials and methods. Imaging – echocardiography (Echo), electrocardiography, multispiral computed tomography, coronary angiography. Bioprosthetic valve calcification and stenosis with critical parameters of the bioprosthetic AV peak pressure gradient according to Echo data were the indications for minimally invasive surgery. Results. Dynamic observation revealed a progressive deterioration in the function of the previously implanted bioprosthetic heart valve in the aortic position, and a critical deterioration in the patient’s condition. After additional examination of the patient and selection of a new prosthesis, valve-in-valve transcatheter aortic valve replacement was done. The positive dynamics of the general state of the patient was noted in the early postoperative period. Echo data showed that the bioprosthetic AV peak systolic pressure gradient decreased from 90 to 29 mmHg, average gradient – from 42 to 19 mmHg. Conclusion. The minimally invasive valve-in-valve transcatheter aortic valve replacement used to correct the dysfunction of a bioprosthetic AV that was previously implanted during an open surgery was shown to be safe and effective and can be considered as one of the options for repeat valve replacement.

Transcatheter mitral valve implantation using a novel system: preclinical results.

BackgroundThis preclinical study in sheep sought to demonstrate the initial safety and feasibility of a novel transcatheter mitral valve system (Mi-thos valve) composed of a self-expanding frame and a bovine pericardial tissue bioprosthesis.MethodsThe valve was implanted in 26 sheep using a transapical approach for short- and long-term evaluation. The technical feasibility, safety, durability, and valve function were evaluated during and 6 months after the procedure using intracardiac and transthoracic echocardiography, multisliced computed tomography, histological analysis, and electron microscopy.ResultsThe success rate of valve implantation was 100%, and the immediate survival rate after surgery was 84%. Five animals died within 90 min after the development of the prosthetic valve due to an acute left ventricular outflow tract obstruction (n = 2) and sudden intraoperative ventricular fibrillation (n = 3). Twelve animals died within 1 month due to acute left heart dysfunction. Mild (n = 5) and moderate (n = 2) paravalvular leakage occurred in seven animals, and two moderate PVL animals died of chronic heart failure within three months. Multimodality imaging studies of the remaining seven animals showed excellent function and alignment of the valves, with no coronary artery obstruction, no left ventricular outflow tract obstruction, no severe transvalvular gradients and no paravalvular leakage. Macroscopic evaluation demonstrated stable, secure positioning of the valve, with full endothelialization of the valve leaflets without injury to the ventricular or atrial walls. Histological and electron microscopic examinations at six months showed no obvious macro- or microcalcification in the leaflets.ConclusionsPreclinical studies indicate that transcatheter implantation of the Mi-thos valve is technically safe and feasible. The durability, functionality, and lack of leaflet calcification were all verified in animal experiments. The information from these preclinical studies will be applied to patient selection criteria and the first-in-human studies.

Transapical Transcatheter Aortic Valve Implantation in Ukraine: Primary Experience in XPand Device Usage

Background. Recent developments in the field of transcatheter aortic valve implantation (TAVI) have led to arised interest for the optimization of this procedure and related devices for patients with severe aortic valve stenosis. This is the first study to examine novel XPand device, jointly developed by German, French and Ukrainian scientists. This study aims to contribute to this growing area of research by exploring efficacy and safety in patients with severe aortic stenosis. Objective. To evaluate the procedure effectiveness and long-term outcomes for XPand device implantation in patients with severe aortic valve stenosis. Materials and methods. We initiated a single-center clinical trial to evaluate the XPand device and already perform an initial analysis of the primary outcomes. After patients fitted the inclusion criteria full examination they underwent TAVI procedure using the XPand system. Postoperative result evaluation was performed according to the established protocol. Outcomes. Primary good results for TAVI XPand were obtained in all patients (n = 7). The average length of stay in the hospital after the procedure was 20 ± 1.25 days. The postoperative period was unremarkable. In 71.5% of patients the minimal paravalvular insufficiency or insufficiency absence were obtained after the final aortography. Comments. The first experience of using modern device XPand for transcatheter implantation of the aortic valve prosthesis confirms its effectiveness and safety in patients with severe aortic stenosis.

First experience of transcatheter implantation of a Russian-made MedLab-CT prosthesis in a patient with dysfunction of biological mitral valve prosthesis

We present a case report of successful transcatheter implantation of a Russian-made cardiac valve prosthesis in a patient with dysfunction of biological mitral valve prosthesis (valve-in-valve). A patient aged 78 years with a high surgical risk and severe heart failure due to mitral valve bioprosthesis dysfunction is described. Fluoroscopyand transesophageal echocardiography-guided transapical implantation of a MedLab-CT prosthesis (23 mm) was made. When a heart rate of 180 beats per minute, a stent prosthesis was implanted. Transcatheter implant valve functioned properly after surgery. The patient was discharged in satisfactory condition.

Biodegradable synthetic polymeric composite scaffold‐based tissue engineered heart valve with minimally invasive transcatheter implantation

Prosthetic heart valve replacement is the main treatment for valvular heart disease, but the existing artificial valves (mechanical or biological valve) have inherent disadvantages. Patients with mechanical valves require lifelong anticoagulation because of the high risk of thromboembolism, while the durability of biological valve is poor, which easily leads to calcification or lobular degeneration. Besides, they all lack the abilities of self‐repair and growth which are very important for adolescent patients with valvular heart disease. To overcome these shortcomings, the researchers developed tissue engineered heart valves (TEHV) with self‐repairing and remodeling capabilities, low immunogenicity, and great durability. The preparation of three‐dimensional porous scaffolds is the key step in the success of TEHV. Because of their easy processing, active chemical properties, great mechanical properties and controllable degradation rate, synthetic biodegradable polymers are widely used in the preparation of TEHV scaffolds. This review summarizes the types, properties and process techniques of biodegradable synthetic polymers, such as polycaprolactone, polyglycolic acid, polylactic acid, and polyhydroxyalkanoates currently used to prepare the TEHV scaffolds. This review also focuses on the composite methods and performance of synthetic polymer‐based composite scaffolds. The prospects and challenges of the clinical application for minimally invasive implantation of TEHV are also discussed.

Implante transcateter de válvula aórtica em paciente com duas malignidades: estenose aórtica e câncer de cólon

An octogenarian female patient, admitted for heart failure secondary to severe aortic stenosis decompensated by atrial fibrillation, with a high ventricular response. When clinically compensated, she was discharged on oral anticoagulation with a direct-acting anticoagulant, for outpatient scheduling of a transcatheter implantation of aortic valve bioprosthesis. She was readmitted early due to low digestive bleeding secondary to locally advanced stenosing colon cancer. After discussion with the Heart Team and the oncology team, a transcatheter implantation of aortic valve bioprosthesis [...]

Initial experience with Edwards SAPIEN valve transcatheter implantation in native RVOT in Latvia.

Transcatheter pulmonary valve implantation has been awell-known method for more than adecade, but there are still many challenging cases when apersonalized solution is needed. We report acase of a15-year-old female patient with tetralogy of Fallot, who underwent a surgical correction during infancy. Because of progressive pulmonary regurgitation, stenosis, and right ventricle dilatation, transcatheter pulmonary valve implantation in thenative right ventricle outflow tract (RVOT) using Edwards SAPIEN valve was performed. A"landing zone" was created prior to theintervention of stenting theRVOT and theright pulmonary artery. Thetranscatheter approach for pulmonary valve replacement in anative RVOT is areasonable alternative to thesurgical approach.

Перший досвід застосування в Україні системи NVT Allegra для транскатетерної імплантації протеза аортального клапана та перспективи рутинних інтервенційних втручань на клапані аорти

Мета роботи – представити перший в Україні досвід використання приладу NVT Allegra для проведення процедури транскатетерної імплантації протеза аортального клапана (TAVI) пацієнтам з високим хірургічним ризиком із вираженим аортальним стенозом.Матеріали і методи. У статті наведені клінічні випадки двох пацієнтів віком 90 та 80 років із вираженим аортальним стенозом із середніми градієнтами трансаортального кровотоку 32 та 76 мм рт. ст. та площею відкриття аортального клапана 0,4 та 0,6 см2 відповідно. Обидва пацієнти були визнані хворими з високим хірургічним ризиком.Результати та обговорення. Обом пацієнтам була проведена транскатетерна імплантація протеза аортального клапана трансфеморальним доступом. Після імплантації середні градієнти трансаортального кровотоку становили 13 та 8 мм рт. ст. відповідно. Резидуальна параклапанна недостатність була невеликого ступеня в обох випадках. Висновки. Система NVT Allegra для проведення транскатетерної імплантації протеза аортального клапана є приладом третього покоління, який дозволяє успішно та безпечно виконувати інтервенційну заміну клапана аорти.