Under pressure: The first valve-in-valve transcatheter aortic valve implantation for stenosis of a BioValsalva prosthesis using a Sapien 3 Ultra balloon expandable valve in a patient with complex congenital heart disease

In-Hospital Outcome In Patients With Acyanotic Congenital Heart Disease Undergoing Transcatheter Aortic Valve Replacement.

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Advances in the diagnosis and management of congenital heart disease (CHD) have resulted in an increased number of patients living into adulthood. Despite increased survival, these patients often require surgery at a young age and are susceptible to developing complications related to the degeneration of surgical prostheses and valves. This case describes to our knowledge, the first successful balloon expandable valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) for stenosis of a BioValsalva stentless aortic graft in a patient with complex congenital heart disease and two prior sternotomies. Prior to ViV-TAVI, the patient was critically ill and unable to be weaned from intensive care unit supports due to recurrent pulmonary oedema. Our case demonstrates successful ViV-TAVI in what was considered an extreme-risk patient. This procedure enabled the patient to be rapidly weaned from respiratory supports and discharged seven days post-procedure.

Case report Under pressure: The first valve-in-valve transcatheter aortic valve implantation for stenosis of a BioValsalva prosthesis using a Sapien 3 Ultra balloon expandable valve in a patient with complex congenital heart disease

Aim This study sought to evaluate the feasibility and effectiveness of TAVI for treatment of aortic stenosis in the ACHD population. Methods and Results Review of 802 patients that underwent TAVI from January 2008 to November 2019. 13 ACHD patients with different underlying congenital anatomy were identified (isolated bicuspid aortic valve was excluded and not defined as ACHD). The main endpoints were: paravalvular aortic regurgitation> grade 2 post-procedure, and all-cause 30-day mortality. Periprocedural and post-procedural complications were defined according to the UK TAVI registry. Median age was 66.7 years (range 29–84 years). Eleven patients had severe aortic stenosis (AS), 1 had both severe AS and severe aortic regurgitation (AR) and 1 had severe AR. Median hospital stay was 9 days (range 6–28 days). One patient required a pacemaker post-TAVI. No mortality or paravalvular AR > grade 2 at 30-days. Twelve patients had a reduction in NYHA class on their first post TAVI follow-up. Conclusion TAVI is viable option as an alternative to surgery for ACHD patients. Further experience with the use of TAVI in the ACHD patients is required to assess long-term outcomes in this unique group of patients.

Feasibility and Effectiveness of Transcatheter Aortic Valve Implantation in Adults with Congenital Heart Disease

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Feasibility and Effectiveness of Transcatheter Aortic Valve Implantation in Adults with Congenital Heart Disease