Fluoroscopic Guide to an Ideal Implant Position for Sapien XT and CoreValve During a Valve-in-Valve Procedure

Vinnie N. Bapat; Rizwan Q. Attia; Fortunata Condemi; Ravi Visagan; Maya Guthrie; Shelina Sunni; Martyn Thomas

doi:10.1016/j.jcin.2013.05.020

Fluoroscopic Guide to an Ideal Implant Position for Sapien XT and CoreValve During a Valve-in-Valve Procedure

Vinnie N. Bapat^*, Rizwan Q. Attia, Fortunata Condemi, Ravi Visagan, Maya Guthrie, Shelina Sunni, Martyn Thomas

^*Corresponding author for this work

GSTT Guy's and St Thomas' NHS Foundation Trust

Research output: Contribution to journal › Article › peer-review

38 Citations (Scopus)

Abstract

Objectives
This study sought to provide a guide to the fluoroscopic appearances of various valve-in-valve (VIV) combinations by deploying a transcatheter heart valve (THV) within a degenerated surgical heart valve (SHV) in an ideal position.

Background
VIV procedures are being increasingly performed with substantial experience acquired in treating degenerated SHV in the aortic position with Sapien/Sapien XT (Edwards Lifesciences Ltd., Irvine, California) and CoreValve/Evolute (Medtronic Inc., Minneapolis, Minnesota) valves. Although less invasive than conventional surgery, securing the THV in an optimal position within the SHV determines the success of this novel treatment.

Methods
For VIV implantation, we selected appropriate Sapien XT and CoreValve/Evolute sizes depending on the internal diameter of the SHV. Implantation was performed in vitro. In case of the Sapien XT valve, it was deployed 4 to 5 mm below the sewing ring of the SHV, whereas the CoreValve/Evolute was deployed 5 mm below the level of the sewing ring. Photographs and fluoroscopic images of the various VIV combinations were obtained in side profile to study the ideal position and end-on profile to study the circularity of the THV.

Results
Fluoroscopic images obtained in side profile highlighted the differences in various VIV combinations, as all SHV are unique in their fluoroscopic appearances. Also, all THV implants in various VIV combinations achieved a nearly circular shape.

Conclusions
To achieve an optimal result when considering VIV, it is important to be familiar with the structure and fluoroscopic appearances of the failed SHV, the THV used, and their combination.

Original language	English
Pages (from-to)	1186-1194
Number of pages	9
Journal	Jacc-Cardiovascular Interventions
Volume	6
Issue number	11
DOIs	https://doi.org/10.1016/j.jcin.2013.05.020
Publication status	Published - Nov 2013

Keywords

bioprosthesis
transcatheter aortic valve implantation
transcatheter valve
valve-in-valve
valve replacement
TRANSCATHETER
BIOPROSTHESES
REPLACEMENT

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10.1016/j.jcin.2013.05.020

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@article{525bc1eedfb246899d88a9a2a96e5e21,

title = "Fluoroscopic Guide to an Ideal Implant Position for Sapien XT and CoreValve During a Valve-in-Valve Procedure",

abstract = "Objectives This study sought to provide a guide to the fluoroscopic appearances of various valve-in-valve (VIV) combinations by deploying a transcatheter heart valve (THV) within a degenerated surgical heart valve (SHV) in an ideal position. Background VIV procedures are being increasingly performed with substantial experience acquired in treating degenerated SHV in the aortic position with Sapien/Sapien XT (Edwards Lifesciences Ltd., Irvine, California) and CoreValve/Evolute (Medtronic Inc., Minneapolis, Minnesota) valves. Although less invasive than conventional surgery, securing the THV in an optimal position within the SHV determines the success of this novel treatment. Methods For VIV implantation, we selected appropriate Sapien XT and CoreValve/Evolute sizes depending on the internal diameter of the SHV. Implantation was performed in vitro. In case of the Sapien XT valve, it was deployed 4 to 5 mm below the sewing ring of the SHV, whereas the CoreValve/Evolute was deployed 5 mm below the level of the sewing ring. Photographs and fluoroscopic images of the various VIV combinations were obtained in side profile to study the ideal position and end-on profile to study the circularity of the THV. Results Fluoroscopic images obtained in side profile highlighted the differences in various VIV combinations, as all SHV are unique in their fluoroscopic appearances. Also, all THV implants in various VIV combinations achieved a nearly circular shape. Conclusions To achieve an optimal result when considering VIV, it is important to be familiar with the structure and fluoroscopic appearances of the failed SHV, the THV used, and their combination.",

keywords = "bioprosthesis, transcatheter aortic valve implantation, transcatheter valve, valve-in-valve, valve replacement, TRANSCATHETER, BIOPROSTHESES, REPLACEMENT",

author = "Bapat, {Vinnie N.} and Attia, {Rizwan Q.} and Fortunata Condemi and Ravi Visagan and Maya Guthrie and Shelina Sunni and Martyn Thomas",

year = "2013",

month = nov,

doi = "10.1016/j.jcin.2013.05.020",

language = "English",

volume = "6",

pages = "1186--1194",

journal = "Jacc-Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "11",

}

TY - JOUR

T1 - Fluoroscopic Guide to an Ideal Implant Position for Sapien XT and CoreValve During a Valve-in-Valve Procedure

AU - Bapat, Vinnie N.

AU - Attia, Rizwan Q.

AU - Condemi, Fortunata

AU - Visagan, Ravi

AU - Guthrie, Maya

AU - Sunni, Shelina

AU - Thomas, Martyn

PY - 2013/11

Y1 - 2013/11

N2 - Objectives This study sought to provide a guide to the fluoroscopic appearances of various valve-in-valve (VIV) combinations by deploying a transcatheter heart valve (THV) within a degenerated surgical heart valve (SHV) in an ideal position. Background VIV procedures are being increasingly performed with substantial experience acquired in treating degenerated SHV in the aortic position with Sapien/Sapien XT (Edwards Lifesciences Ltd., Irvine, California) and CoreValve/Evolute (Medtronic Inc., Minneapolis, Minnesota) valves. Although less invasive than conventional surgery, securing the THV in an optimal position within the SHV determines the success of this novel treatment. Methods For VIV implantation, we selected appropriate Sapien XT and CoreValve/Evolute sizes depending on the internal diameter of the SHV. Implantation was performed in vitro. In case of the Sapien XT valve, it was deployed 4 to 5 mm below the sewing ring of the SHV, whereas the CoreValve/Evolute was deployed 5 mm below the level of the sewing ring. Photographs and fluoroscopic images of the various VIV combinations were obtained in side profile to study the ideal position and end-on profile to study the circularity of the THV. Results Fluoroscopic images obtained in side profile highlighted the differences in various VIV combinations, as all SHV are unique in their fluoroscopic appearances. Also, all THV implants in various VIV combinations achieved a nearly circular shape. Conclusions To achieve an optimal result when considering VIV, it is important to be familiar with the structure and fluoroscopic appearances of the failed SHV, the THV used, and their combination.

AB - Objectives This study sought to provide a guide to the fluoroscopic appearances of various valve-in-valve (VIV) combinations by deploying a transcatheter heart valve (THV) within a degenerated surgical heart valve (SHV) in an ideal position. Background VIV procedures are being increasingly performed with substantial experience acquired in treating degenerated SHV in the aortic position with Sapien/Sapien XT (Edwards Lifesciences Ltd., Irvine, California) and CoreValve/Evolute (Medtronic Inc., Minneapolis, Minnesota) valves. Although less invasive than conventional surgery, securing the THV in an optimal position within the SHV determines the success of this novel treatment. Methods For VIV implantation, we selected appropriate Sapien XT and CoreValve/Evolute sizes depending on the internal diameter of the SHV. Implantation was performed in vitro. In case of the Sapien XT valve, it was deployed 4 to 5 mm below the sewing ring of the SHV, whereas the CoreValve/Evolute was deployed 5 mm below the level of the sewing ring. Photographs and fluoroscopic images of the various VIV combinations were obtained in side profile to study the ideal position and end-on profile to study the circularity of the THV. Results Fluoroscopic images obtained in side profile highlighted the differences in various VIV combinations, as all SHV are unique in their fluoroscopic appearances. Also, all THV implants in various VIV combinations achieved a nearly circular shape. Conclusions To achieve an optimal result when considering VIV, it is important to be familiar with the structure and fluoroscopic appearances of the failed SHV, the THV used, and their combination.

KW - bioprosthesis

KW - transcatheter aortic valve implantation

KW - transcatheter valve

KW - valve-in-valve

KW - valve replacement

KW - TRANSCATHETER

KW - BIOPROSTHESES

KW - REPLACEMENT

U2 - 10.1016/j.jcin.2013.05.020

DO - 10.1016/j.jcin.2013.05.020

M3 - Article

SN - 1936-8798

VL - 6

SP - 1186

EP - 1194

JO - Jacc-Cardiovascular Interventions

JF - Jacc-Cardiovascular Interventions

IS - 11

ER -

Fluoroscopic Guide to an Ideal Implant Position for Sapien XT and CoreValve During a Valve-in-Valve Procedure

Abstract

Keywords

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