RESULTS OF TRANSCATHETER REPROSTHETICS OF THE AORTIC VALVE

Ivan V. Ganyukov; Ivan V. Dvadtsatov; Irina N. Mamchur; Roman S. Tarasov; Vladimir I. Ganyukov

RESULTS OF TRANSCATHETER REPROSTHETICS OF THE AORTIC VALVE

Ivan V. Ganyukov, Ivan V. Dvadtsatov, Irina N. Mamchur, Roman S. Tarasov, Vladimir I. Ganyukov

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Abstract

Highlights

The study demonstrates the possibility of successful repeated endovascular intervention in case of dysfunction of a previously implanted bioprosthesis, which opens up new prospects in the treatment of patients with complications after aortic valve replacement.
The study showed the high efficiency and safety of the method: technical success was achieved in all 8 cases, while no deaths, strokes or other serious complications were recorded during the 12 months of follow-up.
The clinical effectiveness of the method is confirmed by the positive dynamics of EchoCG parameters (reduction of pressure gradient, disappearance of severe regurgitation, reduction of LV hypertrophy) and improvement of patients’ condition.

Aim. To evaluate the safety and effectiveness of transcatheter prosthetics of the aortic valve (TPAK) using the valve-in-valve method in patients with bioprosthesis dysfunction in the aortic position based on the analysis of the results of the first endovascular reprosthetics procedures at the Scientific Research Institute of Complex Problems of Cardiovascular Diseases (NII KPSSZ).

Methods. The present study included 8 patients with aortic bioprosthesis dysfunction who underwent valve-to-valve transfemoral access during this time period. Of the 8 valve-to-valve surgical procedures, 7 endovascular interventions were performed due to the development of dysfunctions of biological prostheses in the aortic position after open surgery and in 1 case after the primary surgical procedure. Average STS Score = 8.4%. The main types of dysfunction were primary tissue failure with rupture of xenospores and the formation of insufficiency (n = 5) and calcium degeneration of the biological valve with the appearance of a stenotic effect (n = 3). The endpoints were evaluated for efficiency and safety and were divided into 3 blocks: 1) Clinical results; 2) Complications; 3) EchoCG data. The results were evaluated 30 days after the intervention and after 12 months.

Results. The average duration of aortic valve function after primary arthroplasty until the first signs of dysfunction was 5.3 (3.1; 11.9) years. After valve-to-valve TPA with transfemoral access, death from all causes, cardiovascular death, periprocedural death, stroke, TIA, myocardial infarction, vascular complications, cardiac complications, bleeding (on the BARC scale), arrhythmological events, prosthetic dysfunction requiring reoperative, infectious endocarditis were not noted not in any case. The technical success of TPAC, which was assessed only during the period of hospitalization, was noted in all cases. Only one patient (16.67%) was hospitalized for CHF decompensation at the 12-month follow-up stage with satisfactory indicators of aortic bioprosthesis function according to EchoCG. According to the EchoCG data between the period before reprosthetics and 12 months after, there was a significant positive trend in terms of maximum velocity and maximum gradient per AC. At the same time, the changes in the average velocity and average gradient were not significant. Grade III–IV transprosthetic regurgitation before reprosthetics was observed in 4 patients (50%), and in dynamics it disappeared (only grade I regurgitation or its complete absence is noted), as well as regurgitation on grade III–IV MK was observed in 5 patients (62.5%), and in dynamics it disappeared (regurgitation is noted only of I and II degrees). LV hypertrophy became less pronounced in dynamics (average myocardial mass index after TPAK = 109.5 g/m²).

Conclusion. After valve-to-valve TPA with transfemoral access performed at the KPSSZ Research Institute, favorable results were shown after 30 days and 12 months. The low number of intra- and postoperative complications, the positive dynamics of the clinical status of patients and structural and functional parameters assessed by EchoCG led to a positive conclusion on the safety and effectiveness of the presented method of treatment of patients with aortic bioprosthesis dysfunction.