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P188
Transcatheter Heart Valve Implantation (THVI) as an Alternative to Redo Surgery

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INTRODUCTION

*The trend in cardiac surgery is an increasing number of valvuloplasties and bioprostetic valve implants.

*There is an aging polulation with comorbidities.

*Valvuloplasties fail and bioprostheses degenerate, hence the need of redo surgery increase.

*Transcatheter heart valve implantations (THVI) is evolving and extended “off label “ use is reported for redo valve procedures in all valve positions.

*With the series of 24 patients we show the feasibility and benefit of this technique in all valve positions, even extra anatomical, for both stented and stentless bioprostetic valves and valvuloplasty rings.

 

METHOD: PROCEDURAL PLANNING

 

1)Consider if it is regurgitation or stenosis for choosing the right catheter valve
2)Sizing: CT reconstruction of the valve, Vinnie Bapat’s Apps, bench test, 3D printing
3)For mitral: obs LVOT obstruction (Aorto-mitral angle)
4)Periprocedural imaging : Evaluate radiopaque landmarks in the implanted valve or ring
5)Access : CT of thorax and vessels for evaluation
6)Perform the procedure in a hybrid operation room
 

CONCLUSION

*Valve-in-valve/ring is feasible in all valve positions of the heart. It can be done in stented and stentless prostheses, in homografts or annuloplasty rings, for both regurgitation and/or stenosis

*Precise, spesific and custom made planning of the procedure is crucial

*A central access facilitates exact positioning and alignment. Surgeons in the transcatheter heart team make this possible

*Partial bypass may be useful

*Valve-in-valve/ring is a safe procedure for selected high risk patients, including GUCH patients with abnormal anatomy

*The THVI may reduce the mortality in redo-valve surgery

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