Mohammed Nejjari

Transfemoral Implantation of Transcatheter Heart Valves After Deterioration of Mitral Bioprosthesis or Previous Ring Annuloplasty

OBJECTIVES This study sought to evaluate the feasibility of transfemoral transcatheter heart valve (THV) implantation in failed mitral bioprostheses and ring annuloplasties. BACKGROUND Redo mitral surgery may be high risk or contraindicated due to comorbidity. THV implantation has been recently reported in this setting. METHODS Transfemoral implantation of Edwards Sapien prosthesis was performed in 17 patients for degenerated mitral bioprosthesis or previous ring annuloplasty (6 bioprostheses, 11 ring annuloplasties). The procedure was elective for 14 patients and attempted as a rescue in 3 patients. Mean age was 61 ± 24 years. All patients were in New York Heart Association class ≥III, and the surgical risk was high (EuroSCORE [European System for Cardiac Operative Risk Evaluation]: 37 ± 29%, Society of Thoracic Surgeons score: 18 ± 22%). RESULTS Procedure was successful in 14 patients (82%). Two complications occurred during rescue procedures: 1 procedural death and 1 THV migration. One patient had moderate paraprosthetic regurgitation following the procedure, whereas residual regurgitation was trace or less in 11 patients (69%) and mild in 4 patients (25%). Mean gradient decreased from 12 ± 6 mm Hg to 8 ± 3 mm Hg. During a mean follow-up of 22 months, 4 patients died, 3 from cardiac cause. The 18-month survival was 68 ± 14% in the overall population and 78 ± 14% for patients with elective procedure. One patient underwent mitral valve replacement due to periprosthetic mitral regurgitation. At last follow-up, 12 patients were in New York Heart Association class ≤II (75%) and 4 in class III (25%). CONCLUSIONS This single-center series suggests that transfemoral THV implantation for deterioration of mitral bioprosthesis or surgical repair is feasible in selected patients and improves early hemodynamic and midterm functional status.

Transcatheter valve replacement in patients with severe mitral valve disease and annular calcification.

Patients with extensive mitral annular calcification (MAC) may have an inoperable condition because of insurmountable technical issues. Four cases have suggested the feasibility of transcatheter mitral valve replacement (TMVR) in these patients [(1–4)][1]. We report here the first series of

Transfemoral Tricuspid Valve-in-Ring Implantation Using the Edwards Sapien XT Valve One-Year Follow-Up

Between November 2012 and August 2013, after multidisciplinary evaluation, 3 high-risk patients underwent transfemoral tricuspid valve-in-ring implantation (TVIRI) for refractory congestive heart failure because of deterioration of their tricuspid surgery, using Sapien XT valves (Edwards Lifesciences Inc, Irvine, CA). Patient 1: 44-year-old man, drug abuse, 4 episodes of tricuspid endocarditis, 2 previous cardiac surgeries for mitral homograft in tricuspid position with 30-mm Classic Carpentier Edwards annuloplasty ring (2001), presenting with massive central tricuspid regurgitation (TR; Figure 1A). Figure 1. Color transesophageal echocardiography (TEE) image of tricuspid regurgitation (TR) before implantation on the left panels. A , Patient 1: severe TR with 2 jets, one emanating from the center of the homograft and the second from the medial part of the prosthetic annulus. B , Patient 2: severe central intraprosthetic jet. C , Patient 3: severe central intraprosthetic jet. Color TEE image of TR after valve-in-ring implantation on the right panels: A′ , Patient 1: mild residual TR with an excentric jet coming from the medial part of the prosthetic annulus. Mid-esophageal two-dimensional (2D) TEE view at 0°, compare black and white and color Doppler. B′ , Patient 2: trace TR coming from the medial part of the prosthetic annulus. Mid-esophageal 2D TEE view at 90°, compare black and white and color Doppler. C′ , Patient 3: moderate-to-severe residual paravalvular TR with a jet coming from …

First-in-man full percutaneous transfemoral valve-in-valve implantations using Edwards SAPIEN 3 prostheses to treat a patient with degenerated mitral and aortic bioprostheses

We report the case of a 64-year old man presenting with pulmonary oedema due to the degeneration of mitral and aortic bioprostheses. Baseline transthoracic and 3D transoesophageal echocardiography showed severe stenotic degeneration of the mitral bioprosthesis (Carpentier-Edwards bioprosthesis n°31), severe intraprosthetic aortic regurgitation (Perimount bioprosthesis n°27), left ventricular dilatation, decreased left ventricular ejection fraction at 50% and pulmonary hypertension. Because of severe comorbidities, the patient was denied redo surgery by the Heart Team (logistic EuroSCORE 2: 23, 85%). Transcatheter transfemoral mitral valve-in-valve implantation was first performed using a 29-mm SAPIEN 3 valve. Two weeks later, aortic valve-in-valve implantation was performed with the same approach using a 26-mm SAPIEN 3 valve. Four months later, the patient remained asymptomatic with good haemodynamic results for both prostheses. This case report illustrates that valve-in-valve implantations using a full percutaneous transfemoral approach may be a valuable alternative to conventional surgery in high-risk patients presenting with concomitant mitral and aortic bioprosthesis dysfunction.

Spectral Contrast-Enhanced Cardiac Computed Tomography for Diagnosis of Acute Myocarditis

Spectral Contrast-Enhanced Cardiac Computed Tomography for Diagnosis of Acute Myocarditis Zaven Terzian, MS, Marie-C ecile Henry-Feugeas, MD, PhD, Gilles Billebeau, MS, Mohammed Nejjari, MD, Gr egory Ducrocq, MD, Marie-Pierre Debray, MD, Phillipe Gabriel Steg, MD, PhD, and Phalla Ou, MD, PhD Department of Cardiology, University Paris Diderot, Hopital Bichat, APHP, Paris, France Department of Radiology, University Paris Diderot, Hopital Bichat, APHP, Paris, France

How to treat severe symptomatic structural valve deterioration of aortic surgical bioprosthesis: transcatheter valve-in-valve implantation or redo valve surgery?

The optimal management of aortic surgical bioprosthesis presenting with severe symptomatic structural valve deterioration is currently a matter of debate. Over the past 20 years, the number of implanted bioprostheses worldwide has been rapidly increasing at the expense of mechanical prostheses. A large proportion of patients, however, will require intervention for bioprosthesis structural valve deterioration. Current options for older patients who often have severe comorbidities include either transcatheter valve-in-valve (TVIV) implantation or redo valve surgery. The emergence of TVIV implantation, which is perceived to be less invasive than redo valve surgery, offers an effective alternative to surgery for these patients with proven safety and efficacy in high-risk patient groups including elderly and frail patients. A potential caveat to this strategy is that results of long-term follow-up after TVIV implantation are limited. Redo surgery is sometimes preferable, especially for young patients with a smaller-sized aortic bioprosthesis. With the emergence of TVIV implantation and the long experience of redo valve surgery, we currently have 2 complementary treatment modalities, allowing a tailor-made and patient-orientated intervention. In the heart team, the decision-making should be based on several factors including type of bioprosthesis failure, age, comorbidities, operative risk, anatomical factors, anticipated risks and benefits of each alternative, patients choice and local experience. The aim of this review is to provide a framework for individualized optimal treatment strategies in patients with failed aortic surgical bioprosthesis.

TCT-161 Impact of Pre-existent Prosthesis-Patient Mismatch on Survival Following Aortic Valve-in-Valve Procedures

Transcatheter valve-in-valve (ViV) implantation is an alternative for the treatment of patients with degenerated bioprostheses. Small label size of the surgical valve was associated with increased mortality after ViV. Our objective was to determine whether this association is, at least in part,

0026 : Transfemoral tricuspid valve-in-valve and valve-in-ring implantation using the Edwards SAPIEN XT valve: one-year follow-up

Background Redo tricuspid surgery may be at high risk or even contraindicated in patients with comorbidities. Transcatheter valve implantation (TVI) has been recently reported in this setting. The aim of this study was to evaluate the early and 1-year outcomes of TVI with Edwards SAPIEN XT valves in failed tricuspid bioprostheses (BP) and ring annuloplasty (RA). Methods and Results TVI was performed in 6 patients for failed tricuspid surgical valves (3 BP, 3 RA). Median patient age was 58 years, all were in New York Heart Association (NYHA) class≥III and 5 out of 6 had previously undergone at least 2 cardiac interventions. The procedure was successful in the 3 patients with BP and 2 with RA; one patient had a moderate paravalvular regurgitation at the level of the open portion of a rigid incomplete ring. Otherwise, regurgitation was absent in 3 patients, trace in 1 and mild in 1. The transvalvular gradient decreased from 8 mmHg at baseline to 4 mmHg at day 7. At 1-year follow-up, survival was 100%. Tricuspid gradients remained stable in all but 1 patient, as well as regurgitation grades. Only 1 patient was in NYHA class III, 2 were in class II and 3 in class I. Conclusions Transfemoral TVI with SAPIEN XT valves after failed tricuspid surgery is feasible in selected high-risk patients, with good early and 1-year hemodynamic and clinical results. However, RA may raise issues due to their oval shape and open configuration.