A New Technique to Implant a Transcatheter Inflatable, and Fully Repositionable Prosthesis in Aortic Stenosis with Severe Asymmetric Calcification

H. Bushnaq; D. Metz; T. Neitzel; U. Hofmann; C. Raspé; H. Treede

doi:10.1055/s-0036-1571492

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Thorac Cardiovasc Surg 2016; 64 - OP24
DOI: 10.1055/s-0036-1571492

A New Technique to Implant a Transcatheter Inflatable, and Fully Repositionable Prosthesis in Aortic Stenosis with Severe Asymmetric Calcification

H. Bushnaq ¹, D. Metz ¹, T. Neitzel ¹, U. Hofmann ², C. Raspé ³, H. Treede ¹

¹Halle-Wittenberg University, Department of Cardiac Surgery, Halle, Germany
²Halle-Wittenberg University, Department of Internal Medicine, Cardiovascular Division, Halle, Germany
³Halle-Wittenberg University, Department of Anesthesiology and Critical Care Medicine, Halle, Germany

Congress Abstract

Objective: In contrast to standard TAVI valves, the Direct Flow Medical valve (DFM) (DFM, Santa Rosa, California, United States) is a unique non-metallic bovine aortic bioprosthesis. Extreme asymmetric calcification could cause residual trans-aortic pressure gradient. Here, we report a new valvuloplasty supported implant (VSI) technique, which we developed in our laboratory to optimize DFM implantation.

Methods: Between January 2014 and May 2015, 55 patients underwent TAVI with the DFM valve at our institution, 4 patients were implanted using the VSI technique, due to residual intra-operative trans-aortic gradient above 15 mm Hg. VSI technique was used in 3 transfemoral patients and one direct aortic patient.

Results: The mean age of the patients was 70 ± 5,7 years, the mean logistic EuroSCORE was 29%, and the mean Society of the Thoracic Surgeons score 7.5%, with a mean ejection fraction of 31%. After valve implantation, the transvalvular gradient improved immediately after VSI, from 19.7 ± 2.2 to 6.5 ± 1.2 mm Hg, and remained stable out to 30 days at 11.3 mm Hg. Paravalvular aortic regurgitation was none in 3 patients and trace in one patient. There was no need for permanent pacemaker, and stroke did not occur. All patients survived the first 30 days.

Conclusion: In a limited series of patients, we demonstrated that implant supported valvuloplasty is a feasible, safe and effective technique in selected patients with severe asymmetric calcification and appears to have no adverse effect on valve structure or performance.