Case report
Sequential transcatheter aortic valve implantation due to valve dislodgement - a Portico valve implanted over a CoreValve bioprosthesis
Implantação sequencial de válvula aórtica percutânea por deslocamento da válvula – uma válvula Portico implantada sobre uma CoreValve
Rui Campante Telesa,b,
, Cátia Costac, Manuel Almeidaa, João Britoa, Lars Sondergaardd, José P. Nevese, João Abecasisa, Henrique M. Gabriela
Corresponding author
a Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide, Portugal
b Centro de Estudos de Doenças Crónicas (CEDOC), Faculdade de Ciências Médicas, Lisboa, Portugal
c Serviço de Cardiologia, Hospital de Santarém, Santarém, Portugal
d Serviço de Cardiologia, Rigshospitalet, Copenhagen, Denmark
e Serviço de Cirurgia Cardiotorácica, Hospital de Santa Cruz, Carnaxide, Portugal
Read
6265
Timeswas read the article
1646
Total PDF
4619
Total HTML
Share statistics
array:25 [ "pii" => "S2174204917300612" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.03.012" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "954" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2017;36:215.e1-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2844 "formatos" => array:3 [ "EPUB" => 174 "HTML" => 2319 "PDF" => 351 ] ] "Traduccion" => array:1 [ "en" => array:20 [ "pii" => "S0870255117300689" "issn" => "08702551" "doi" => "10.1016/j.repc.2016.03.012" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "954" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2017;36:215.e1-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3176 "formatos" => array:3 [ "EPUB" => 192 "HTML" => 2502 "PDF" => 482 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Sequential transcatheter aortic valve implantation due to valve dislodgement - a Portico valve implanted over a CoreValve bioprosthesis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "215.e1" "paginaFinal" => "215.e4" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Implantação sequencial de válvula aórtica percutânea por deslocamento da válvula – uma válvula Portico implantada sobre uma CoreValve" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 992 "Ancho" => 1983 "Tamanyo" => 272672 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Sequential procedures during the second intervention. (A and B) Percutaneous coronary intervention of the mid left anterior descending artery with a drug-eluting stent; (C) transfemoral transcatheter aortic valve implantation (valve-in-valve) under three-dimensional transesophageal echocardiographic guidance, the Medtronic CoreValve<span class="elsevierStyleSup">®</span> being immobilized with a 15 mm snare loop by a radial approach; (D) aortic valve balloon valvuloplasty performed with a 20 mm NuMED Nucleus balloon, followed by (E and F) implantation of a 25 mm St. Jude Portico<span class="elsevierStyleSup">®</span> valve; (G) this valve was underexpanded and post-dilation was performed after changing the Amplatz super stiff wire for a backup Meier wire in order to advance the Nucleus balloon; (H) final result.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rui Campante Teles, Cátia Costa, Manuel Almeida, João Brito, Lars Sondergaard, José P. Neves, João Abecasis, Henrique M. Gabriel" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Rui" "apellidos" => "Campante Teles" ] 1 => array:2 [ "nombre" => "Cátia" "apellidos" => "Costa" ] 2 => array:2 [ "nombre" => "Manuel" "apellidos" => "Almeida" ] 3 => array:2 [ "nombre" => "João" "apellidos" => "Brito" ] 4 => array:2 [ "nombre" => "Lars" "apellidos" => "Sondergaard" ] 5 => array:2 [ "nombre" => "José P." "apellidos" => "Neves" ] 6 => array:2 [ "nombre" => "João" "apellidos" => "Abecasis" ] 7 => array:2 [ "nombre" => "Henrique" "apellidos" => "M. Gabriel" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204917300612" "doi" => "10.1016/j.repce.2016.03.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917300612?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117300689?idApp=UINPBA00004E" "url" => "/08702551/0000003600000003/v1_201703130910/S0870255117300689/v1_201703130910/en/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2174204917300247" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.05.010" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "910" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2017;36:217.e1-217.e10" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4927 "formatos" => array:3 [ "EPUB" => 192 "HTML" => 4226 "PDF" => 509 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Arrhythmogenic right ventricular dysplasia: Atypical clinical presentation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "217.e1" "paginaFinal" => "217.e10" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Miocardiopatia arritmogénica do ventrículo direito – particularidades de um caso" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1925 "Ancho" => 3114 "Tamanyo" => 891383 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Electrophysiologic study showing inducibility of monomorphic ventricular tachycardia with complete left bundle branch block.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Marçalo, Luiz Menezes Falcão" "autores" => array:2 [ 0 => array:2 [ "nombre" => "José" "apellidos" => "Marçalo" ] 1 => array:2 [ "nombre" => "Luiz" "apellidos" => "Menezes Falcão" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S0870255116303006" "doi" => "10.1016/j.repc.2016.05.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116303006?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917300247?idApp=UINPBA00004E" "url" => "/21742049/0000003600000003/v1_201703240113/S2174204917300247/v1_201703240113/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2174204917300600" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.10.017" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "953" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "ssu" "cita" => "Rev Port Cardiol. 2017;36:201-14" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4217 "formatos" => array:3 [ "EPUB" => 219 "HTML" => 3193 "PDF" => 805 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Neonatal dilated cardiomyopathy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "201" "paginaFinal" => "214" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Cardiomiopatia dilatada com apresentação neonatal" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Paulo Soares, Gustavo Rocha, Susana Pissarra, Henrique Soares, Filipa Flôr-de-Lima, Sandra Costa, Cláudia Moura, Sofia Dória, Hercília Guimarães" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Paulo" "apellidos" => "Soares" ] 1 => array:2 [ "nombre" => "Gustavo" "apellidos" => "Rocha" ] 2 => array:2 [ "nombre" => "Susana" "apellidos" => "Pissarra" ] 3 => array:2 [ "nombre" => "Henrique" "apellidos" => "Soares" ] 4 => array:2 [ "nombre" => "Filipa" "apellidos" => "Flôr-de-Lima" ] 5 => array:2 [ "nombre" => "Sandra" "apellidos" => "Costa" ] 6 => array:2 [ "nombre" => "Cláudia" "apellidos" => "Moura" ] 7 => array:2 [ "nombre" => "Sofia" "apellidos" => "Dória" ] 8 => array:2 [ "nombre" => "Hercília" "apellidos" => "Guimarães" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255117300665" "doi" => "10.1016/j.repc.2016.10.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117300665?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917300600?idApp=UINPBA00004E" "url" => "/21742049/0000003600000003/v1_201703240113/S2174204917300600/v1_201703240113/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Sequential transcatheter aortic valve implantation due to valve dislodgement - a Portico valve implanted over a CoreValve bioprosthesis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "215.e1" "paginaFinal" => "215.e4" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rui Campante Teles, Cátia Costa, Manuel Almeida, João Brito, Lars Sondergaard, José P. Neves, João Abecasis, Henrique M. Gabriel" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Rui" "apellidos" => "Campante Teles" "email" => array:1 [ 0 => "rcteles@outlook.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Cátia" "apellidos" => "Costa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Manuel" "apellidos" => "Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "João" "apellidos" => "Brito" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Lars" "apellidos" => "Sondergaard" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "José P." "apellidos" => "Neves" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 6 => array:3 [ "nombre" => "João" "apellidos" => "Abecasis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Henrique" "apellidos" => "M. Gabriel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Estudos de Doenças Crónicas (CEDOC), Faculdade de Ciências Médicas, Lisboa, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Serviço de Cardiologia, Hospital de Santarém, Santarém, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Serviço de Cardiologia, Rigshospitalet, Copenhagen, Denmark" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Serviço de Cirurgia Cardiotorácica, Hospital de Santa Cruz, Carnaxide, Portugal" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Implantação sequencial de válvula aórtica percutânea por deslocamento da válvula – uma válvula Portico implantada sobre uma CoreValve" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2701 "Ancho" => 1627 "Tamanyo" => 414991 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The last transthoracic echocardiography (at one-year follow-up) revealing (A and B) partial overlapping of the two bioprostheses (blue asterisk) (two- and three-dimensional respectively); (C) mild to moderate associated periprosthetic leak; (D) appropriate transprosthetic gradients (maximum and mean of 20 mmHg and 10 mmHg, respectively).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Transcatheter aortic valve implantation (TAVI) has become an alternative to surgical aortic valve replacement (SAVR) in high-risk patients with severe aortic stenosis (AS).<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> The complications associated with this procedure are different from those related to SAVR. This article describes the case of a patient who suffered dislocation of a Medtronic CoreValve<span class="elsevierStyleSup">®</span> during initial TAVI treatment. Eventually, after several months of moderate improvement, she needed another intervention, which was performed with a St. Jude Portico<span class="elsevierStyleSup">®</span> repositionable self-expanding transcatheter aortic valve.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">The authors report a case of an 86-year-old woman presenting with New York Heart Association (NYHA) class II symptoms and severe AS (maximum and mean transvalvular gradients of 199 and 75 mmHg, respectively; aortic valve area 0.7 cm<span class="elsevierStyleSup">2</span>). She had preserved left ventricular systolic function and non-significant coronary artery disease, and was rejected for SAVR due to advanced age, low weight and extreme frailty (logistic EuroSCORE I and II 19.79% and 4.22%, respectively; Society of Thoracic Surgeons score 3.7%).</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient underwent a first TAVI in 2012, through angiography-guided femoral access. Valvuloplasty was performed with a 20 mm NuMED Nucleus balloon followed by implantation of a 26 mm CoreValve<span class="elsevierStyleSup">®</span>. During this procedure, the valve became dislodged and migrated to the ascending aorta due to excessive tension on the first-generation delivery catheter making it uncontrollable during fine manipulation of the valve release. A snare technique was used to reposition the prosthesis upward, without affecting the coronaries. Given the fact that valvuloplasty had been performed and the percutaneous aortic valve was of the first generation and not repositionable, it was decided to suspend the procedure and postpone any possible second intervention. The patient's AS became moderate, with maximum and mean gradients decreasing to 67 and 35 mmHg, respectively, and she improved to NYHA class I. No neurologic, aortic or peripheral vascular complications occurred.</p><p id="par0020" class="elsevierStylePara elsevierViewall">One year later her AS worsened (maximum and mean transvalvular gradients of 101 and 61 mmHg, respectively; aortic valve area 0.8 cm<span class="elsevierStyleSup">2</span>) and, in 2014, she was hospitalized for congestive heart failure. The heart team decided on a new TAVI with a repositionable system as the first-line approach, and a balloon-expandable TAVI as a second-line solution. Percutaneous coronary intervention (due to progression of coronary artery disease) was followed by transfemoral TAVI (valve-in-valve) under three-dimensional transesophageal echocardiographic guidance (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). The CoreValve<span class="elsevierStyleSup">®</span> was immobilized with a 15 mm snare loop by a radial approach. After valvuloplasty with a 20 mm Nucleus balloon, a 25 mm Portico<span class="elsevierStyleSup">®</span> valve was implanted. Post-dilation was performed for underexpansion. The patient was prescribed dual antiplatelet therapy with aspirin and clopidogrel until six months after the second procedure.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">At one-year follow-up the patient remains in NHYA class II, with NT-proBNP level of 510 pg/ml. Transthoracic echocardiography revealed the two bioprostheses overlapping with appropriate transprosthetic gradients and associated mild to moderate leak (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Malpositioning of the bioprosthesis during TAVI is a serious procedural complication which needs to be managed promptly to avoid vascular and other systemic complications. Two prospective studies conducted in patients undergoing TAVI using the CoreValve<span class="elsevierStyleSup">®</span> revealed a prevalence of valve dislocation after deployment of 3.2-3.9%, with no long-term vascular or neurological complications.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,3</span></a> Another study observed this complication in about 10% of patients, associated with lower survival rates and higher frequency of coronary ischemia, stroke, and renal failure.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Possible causes of malpositioning are mismatch of the annulus and valve size, which can be solved by precise annulus measurements with echocardiographic and computed tomography imaging; arrhythmias, which hinder stabilization of the valve during deployment (higher ventricular rate pacing is used to stabilize the valve); and by accident, after successful deployment during retraction of the delivery system, if the anchors are not fully released from the deployment catheter or if the tip of the deployment catheter becomes caught at the proximal end of the prosthesis.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Besides morphological or patient-related factors, operator experience appears to be crucial to the prevalence of valve dislocation.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> This was confirmed in a reference center, in which the incidence of CoreValve<span class="elsevierStyleSup">®</span> dislocation decreased constantly with increasing experience over a period of almost three years.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Valve dislocation after complete deployment often results in the need to implant a second prosthesis, which is a feasible and effective interventional option that appears to be safer than retrieving the first prosthesis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The decision whether to insert a new valve inside the previous one, or to pull the first one to another location in the aorta and implant a second valve sequentially, depends on various factors, including operator preferences and procedural circumstances.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> When the two valves are positioned overlapping or partially overlapping each other, there are various disadvantages: duplication of the amount of metal residing against the native aortic wall increases the risk of covering the native coronary ostia and requires more time for endothelialization.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Emergent surgery may be necessary in some cases.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">New transcatheter heart valves have been created in order to overcome some of the limitations of previous systems.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> The Portico<span class="elsevierStyleSup">®</span> is a self-expanding transcatheter aortic bioprosthesis with novel capabilities.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Its ability to be repositioned, recaptured, and redeployed is a desirable feature, especially when the initial implant positioning is suboptimal. However, only small series with limited follow-up have been published.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Only one case of successful Portico<span class="elsevierStyleSup">®</span> transcatheter aortic valve-in-valve implantation, in a patient with a degenerated bioprosthesis (placed surgically), has been described to our knowledge.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> This is the first reported case of TAVI valve-in-valve with this type of bioprosthesis, with good results at 12 months. A valve-in-valve procedure with a self-expanding transcatheter bioprosthesis with repositioning features is presently the first-line solution in cases of degenerated biological prostheses or prosthesis displacement during TAVI. However, assessment of more patients in medium- and long-term follow-up is required.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Dislocation of the bioprosthesis during TAVI is a serious procedural complication which needs to be managed promptly to avoid vascular and other systemic complications. This report describes a successful valve-in-valve procedure after valve dislodgement, with implantation of a self-expanding transcatheter bioprosthesis with repositioning capabilities.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Protection of human and animal subjects</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Confidentiality of data</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Right to privacy and informed consent</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres819571" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec816634" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres819572" "titulo" => "Resumo" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec816633" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack274985" "titulo" => "Acknowledgments" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-01-18" "fechaAceptado" => "2016-03-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec816634" "palabras" => array:3 [ 0 => "Severe aortic stenosis" 1 => "Transcatheter aortic valve implantation complications" 2 => "Valve dislocation" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec816633" "palabras" => array:3 [ 0 => "Estenose aórtica grave" 1 => "Complicações da válvula aórtica percutânea" 2 => "Deslocamento da válvula" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transcatheter aortic valve implantation (TAVI) has become an important treatment in high surgical risk patients with severe aortic stenosis (AS), whose complications need to be managed promptly.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The authors report the case of an 86-year-old woman presenting with severe symptomatic AS, rejected for surgery due to advanced age and comorbidities. The patient underwent a first TAVI, with implantation of a Medtronic CoreValve<span class="elsevierStyleSup">®</span>, which became dislodged and migrated to the ascending aorta. Due to the previous balloon valvuloplasty, the patient's AS became moderate, and her symptoms improved. After several months, she required another intervention, performed with a St. Jude Portico<span class="elsevierStyleSup">®</span> repositionable self-expanding transcatheter aortic valve. There was a good clinical response that was maintained at one-year follow-up.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The use of a self-expanding transcatheter bioprosthesis with repositioning features is a solution in cases of valve dislocation to avoid suboptimal positioning of a second implant, especially when the two valves have to be positioned overlapping or partially overlapping each other.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A implantação de válvula aórtica percutânea (VAP) tornou-se um procedimento importante no tratamento de doentes com estenose aórtica grave com elevado risco cirúrgico, cujas complicações devem ser avaliadas e tratadas de forma adequada.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Os autores relatam o caso de uma doente de 86 anos, com estenose aórtica grave sintomática, recusada para intervenção cirúrgica dada a idade avançada e comorbilidades. A doente foi submetida a uma primeira implantação de VAP com uma válvula <span class="elsevierStyleItalic">Medtronic CoreValve</span><span class="elsevierStyleSup">®</span>, a qual sofreu um deslocamento para a aorta ascendente durante o procedimento. Devido à angioplastia de balão previamente efetuada, a estenose aórtica tornou-se moderada, com melhoria da sintomatologia da doente. Vários meses depois, por agravamento clínico, houve necessidade de reintervenção, a qual foi realizada com um sistema reposicionável <span class="elsevierStyleItalic">Portico</span><span class="elsevierStyleSup">®</span>. Verificou-se um segundo posicionamento valvular adequado, com boa resposta clínica da doente, que persiste após um ano de <span class="elsevierStyleItalic">follow-up</span>.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A utilização de sistemas reposicionáveis de implantação de VAP constitui, atualmente, uma solução em casos de deslocamento da válvula, de forma a evitar uma segunda implantação subótima, sobretudo quando as duas válvulas têm de ficar em sobreposição.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1418 "Ancho" => 2834 "Tamanyo" => 477191 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Sequential procedures during the second intervention. (A and B) Percutaneous coronary intervention of the mid left anterior descending artery with a drug-eluting stent; (C) transfemoral transcatheter aortic valve implantation (valve-in-valve) under three-dimensional transesophageal echocardiographic guidance, the Medtronic CoreValve<span class="elsevierStyleSup">®</span> being immobilized with a 15 mm snare loop by a radial approach; (D) aortic valve balloon valvuloplasty performed with a 20 mm NuMED Nucleus balloon, followed by (E and F) implantation of a 25 mm St. Jude Portico<span class="elsevierStyleSup">®</span> valve; (G) this valve was underexpanded and post-dilation was performed after changing the Amplatz super stiff wire for a backup Meier wire in order to advance the Nucleus balloon; (H) final result.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2701 "Ancho" => 1627 "Tamanyo" => 414991 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The last transthoracic echocardiography (at one-year follow-up) revealing (A and B) partial overlapping of the two bioprostheses (blue asterisk) (two- and three-dimensional respectively); (C) mild to moderate associated periprosthetic leak; (D) appropriate transprosthetic gradients (maximum and mean of 20 mmHg and 10 mmHg, respectively).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter aortic bioprosthesis dislocation: technical aspects and midterm follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Ussia" 1 => "M. Barbanti" 2 => "K. Sarkar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4244/EIJV7I11A203" "Revista" => array:6 [ "tituloSerie" => "Eurointervention" "fecha" => "2012" "volumen" => "7" "paginaInicial" => "1285" "paginaFinal" => "1292" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22433191" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence and management of CoreValve dislocation during transcatheter aortic valve implantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Geisbüsch" 1 => "S. Bleiziffer" 2 => "D. Mazzitelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCINTERVENTIONS.110.944983" "Revista" => array:6 [ "tituloSerie" => "Circ Cardiovasc Interv" "fecha" => "2010" "volumen" => "3" "paginaInicial" => "531" "paginaFinal" => "536" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21063000" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Procedural and mid-term results in patients with aortic stenosis treated with implantation of 2 (in-series) CoreValve prostheses in 1 procedure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "U. Gerckens" 1 => "G. Latsios" 2 => "R. Mueller" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Coll Cardiol Intv" "fecha" => "2010" "volumen" => "3" "paginaInicial" => "244" "paginaFinal" => "250" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transcatheter aortic valve replacement with the St. Jude Medical Portico valve: first-in-human experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Willson" 1 => "J. Rodès-Cabau" 2 => "D.A. Wood" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2012.02.045" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2012" "volumen" => "60" "paginaInicial" => "581" "paginaFinal" => "586" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22657270" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "First-in-man Portico transcatheter aortic valve-in-valve implantation in a degenerated 19 mm Mitroflow aortic pericardial heart valve" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Jeger" 1 => "G. Manoharan" 2 => "C. Kaiser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4244/EIJV9I11A229" "Revista" => array:5 [ "tituloSerie" => "Eurointervention" "fecha" => "2014" "volumen" => "9" "paginaInicial" => "1368" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24534782" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack274985" "titulo" => "Acknowledgments" "texto" => "<p id="par0080" class="elsevierStylePara elsevierViewall">The authors thank Maria Conceição Furstenau (Serviço de Anestesiologia, Hospital Santa Cruz, Carnaxide, Portugal), Regina Ribeiras and Miguel Mendes (Serviço de Cardiologia, Hospital Santa Cruz, Carnaxide, Portugal), and Ana Aleixo (Centro de Estudos de Doenças Crónicas, Faculdade de Ciências Médicas, Lisboa, Portugal).</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003600000003/v1_201703240113/S2174204917300612/v1_201703240113/en/main.assets" "Apartado" => array:4 [ "identificador" => "9919" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003600000003/v1_201703240113/S2174204917300612/v1_201703240113/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917300612?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 5 | 11 |
| 2024 October | 37 | 28 | 65 |
| 2024 September | 38 | 26 | 64 |
| 2024 August | 38 | 29 | 67 |
| 2024 July | 34 | 32 | 66 |
| 2024 June | 39 | 18 | 57 |
| 2024 May | 35 | 26 | 61 |
| 2024 April | 34 | 24 | 58 |
| 2024 March | 28 | 32 | 60 |
| 2024 February | 25 | 42 | 67 |
| 2024 January | 16 | 35 | 51 |
| 2023 December | 22 | 25 | 47 |
| 2023 November | 22 | 19 | 41 |
| 2023 October | 20 | 17 | 37 |
| 2023 September | 31 | 25 | 56 |
| 2023 August | 27 | 9 | 36 |
| 2023 July | 32 | 13 | 45 |
| 2023 June | 25 | 9 | 34 |
| 2023 May | 58 | 21 | 79 |
| 2023 April | 32 | 3 | 35 |
| 2023 March | 55 | 18 | 73 |
| 2023 February | 43 | 22 | 65 |
| 2023 January | 36 | 10 | 46 |
| 2022 December | 49 | 21 | 70 |
| 2022 November | 59 | 23 | 82 |
| 2022 October | 40 | 19 | 59 |
| 2022 September | 35 | 27 | 62 |
| 2022 August | 27 | 25 | 52 |
| 2022 July | 41 | 34 | 75 |
| 2022 June | 40 | 20 | 60 |
| 2022 May | 40 | 23 | 63 |
| 2022 April | 38 | 24 | 62 |
| 2022 March | 29 | 28 | 57 |
| 2022 February | 52 | 30 | 82 |
| 2022 January | 63 | 31 | 94 |
| 2021 December | 33 | 31 | 64 |
| 2021 November | 51 | 44 | 95 |
| 2021 October | 46 | 48 | 94 |
| 2021 September | 45 | 38 | 83 |
| 2021 August | 43 | 33 | 76 |
| 2021 July | 45 | 26 | 71 |
| 2021 June | 30 | 18 | 48 |
| 2021 May | 38 | 32 | 70 |
| 2021 April | 86 | 30 | 116 |
| 2021 March | 57 | 18 | 75 |
| 2021 February | 55 | 22 | 77 |
| 2021 January | 44 | 15 | 59 |
| 2020 December | 38 | 16 | 54 |
| 2020 November | 48 | 19 | 67 |
| 2020 October | 56 | 17 | 73 |
| 2020 September | 53 | 17 | 70 |
| 2020 August | 33 | 10 | 43 |
| 2020 July | 56 | 16 | 72 |
| 2020 June | 44 | 11 | 55 |
| 2020 May | 53 | 3 | 56 |
| 2020 April | 52 | 20 | 72 |
| 2020 March | 29 | 12 | 41 |
| 2020 February | 136 | 27 | 163 |
| 2020 January | 54 | 8 | 62 |
| 2019 December | 34 | 4 | 38 |
| 2019 November | 59 | 7 | 66 |
| 2019 October | 37 | 4 | 41 |
| 2019 September | 65 | 10 | 75 |
| 2019 August | 37 | 3 | 40 |
| 2019 July | 38 | 8 | 46 |
| 2019 June | 36 | 15 | 51 |
| 2019 May | 39 | 8 | 47 |
| 2019 April | 34 | 13 | 47 |
| 2019 March | 118 | 14 | 132 |
| 2019 February | 44 | 9 | 53 |
| 2019 January | 77 | 5 | 82 |
| 2018 December | 24 | 10 | 34 |
| 2018 November | 154 | 5 | 159 |
| 2018 October | 304 | 8 | 312 |
| 2018 September | 99 | 10 | 109 |
| 2018 August | 35 | 7 | 42 |
| 2018 July | 32 | 6 | 38 |
| 2018 June | 60 | 7 | 67 |
| 2018 May | 71 | 14 | 85 |
| 2018 April | 101 | 9 | 110 |
| 2018 March | 109 | 11 | 120 |
| 2018 February | 57 | 6 | 63 |
| 2018 January | 80 | 6 | 86 |
| 2017 December | 123 | 8 | 131 |
| 2017 November | 48 | 5 | 53 |
| 2017 October | 29 | 18 | 47 |
| 2017 September | 28 | 12 | 40 |
| 2017 August | 22 | 15 | 37 |
| 2017 July | 25 | 14 | 39 |
| 2017 June | 35 | 8 | 43 |
| 2017 May | 46 | 17 | 63 |
| 2017 April | 33 | 21 | 54 |
| 2017 March | 15 | 5 | 20 |
Show all
