Norihiko Kamioka

Images in InterventionGrabbing the Transcatheter Valve Skirt: Bail-Out Technique for Valve Embolization During Valve-in-Valve Transcatheter Mitral Valve Replacement

An 80-year-old man with history of coronary artery bypass grafting and mitral annuloplasty with a semirigid Physio-1 ring 30 mm (Edwards Lifesciences, Irvine, California) for ischemic mitral regurgitation was referred to our hospital because of worsening shortness of breath. An echocardiogram

Impact of Aortic Root Anatomy and Geometry on Paravalvular Leak in Transcatheter Aortic Valve Replacement With Extremely Large Annuli Using the Edwards SAPIEN 3 Valve

OBJECTIVES The aim of this study was to determine factors affecting paravalvular leak (PVL) in transcatheter aortic valve replacement (TAVR) with the Edwards SAPIEN 3 (S3) valve in extremely large annuli. BACKGROUND The largest recommended annular area for the 29-mm S3 is 683 mm2. However, experience with S3 TAVR in annuli >683 mm2 has not been widely reported. METHODS From December 2013 to July 2017, 74 patients across 16 centers with mean area 721 ± 38 mm2 (range: 684 to 852 mm2) underwent S3 TAVR. The transfemoral approach was used in 95%, and 39% were under conscious sedation. Patient, anatomic, and procedural characteristics were retrospectively analyzed. Valve Academic Research Consortium-2 outcomes were reported. RESULTS Procedural success was 100%, with 2 deaths, 1 stroke, and 2 major vascular complications at 30 days. Post-dilatation occurred in 32%, with final balloon overfilling (1 to 5 ml extra) in 70% of patients. Implantation depth averaged 22.3 ± 12.4% at the noncoronary cusp and 20.7 ± 9.9% at the left coronary cusp. New left bundle branch block occurred in 17%, and 6.3% required new permanent pacemakers. Thirty-day echocardiography showed mild PVL in 22.3%, 6.9% moderate, and none severe. There was no annular rupture or coronary obstruction. Mild or greater PVL was associated with larger maximum annular and left ventricular outflow tract (LVOT) diameters, larger LVOT area and perimeter, LVOT area greater than annular area, and higher annular eccentricity. CONCLUSIONS TAVR with the 29-mm S3 valve beyond the recommended range by overexpansion is safe, with acceptable PVL and pacemaker rates. Larger LVOTs and more eccentric annuli were associated with more PVL. Longer term follow-up will be needed to determine durability of S3 TAVR in this population.

Biventricular Impella placement via complete venous access

Impella (Abiomed, Danvers, MA) is an effective option for emergent treatment of critical refractory cardiogenic shock. However, in patients who have inadequate peripheral arterial access, Impella for left ventricular support sometimes requires surgical access, leading to disadvantages for emergent procedures or invasiveness for very sick patients. In addition, Impella for right ventricular support was recently reported to contribute to the management of severe biventricular dysfunction. In this report, we describe a case of refractory cardiogenic shock in a patient with inadequate vascular access who was treated with biventricular Impella via venous and caval‐aortic access under conscious sedation. This technique can be used as a bridge to surgical ventricular assist device or heart transplantation.

REPEAT PULMONARY VALVE REPLACEMENT: SIMILAR INTERMEDIATE-TERM OUTCOMES BETWEEN SURGICAL AND TRANSCATHETER PROCEDURES

There is no previous report comparing clinical or echocardiographic outcomes in patients with a history of prior surgical pulmonary valve replacement (SPVR) who undergo repeat SPVR or transcatheter pulmonary valve replacement (TPVR). We retrospectively identified patients who had previous SPVR and

Bedside Modification of Delivery System for Transcatheter Transseptal Mitral Replacement With POULEZ System and SAPIEN-3 Valve

Transcatheter mitral valve replacement (TMVR), using a balloon-expandable valve, recently received approval for degenerated surgical mitral prostheses. It is a relatively straightforward procedure because the prior surgical valve frame enforces coaxiality of the new transcatheter valve. By contrast

Mitral Bioprosthetic Valve Fracture: Bailout Procedure for Undersized Bioprosthesis During Mitral Valve-in-Valve Procedure With Paravalvular Leak Closure

A 76-year-old obese man (body mass index 30.8 kg/m2, body surface area 2.35 m2) with a history of mitral valve replacement and coronary artery bypass grafting was admitted to our hospital with decompensated heart failure. The patient underwent surgical mitral valve replacement with a 25-mm Mosaic

Hybrid Closure of Apical Post-Infarct Septal Defect: Externalizing an Occluder and Excluding the Right Ventricle

A 63-year-old man was transferred to our hospital 5 weeks after an acute anterior myocardial infarction complicated by an apical ventricular septal defect (VSD). He was on intravenous dopamine and required an intra-aortic balloon pump for hemodynamic stability. A large peri-infarct area with a

Radioprotective strategies for interventional echocardiographers during structural heart interventions

We investigated radioprotective strategies for the interventional echocardiographer (IE) during structural heart interventions in comparison with the interventional cardiologist (IC).

Impact of simulated MitraClip on forward flow obstruction in the setting of mitral leaflet tethering: An in vitro investigation

We aimed to evaluate diastolic leaflet tethering as a factor that may cause mitral stenosis (MS) after simulated MitraClip implantation, using an in vitro left heart simulator.

Supra-annular valve strategy for an early degenerated transcatheter balloon-expandable heart valve

Currently, there are no recommendations regarding the selection of valve type for a transcatheter heart valve (THV)‐in‐THV procedure. A supra‐annular valve design may be superior in that it results in a larger effective orifice area and may have a lower chance of valve thrombosis after THV‐in‐THV. In this report, we describe the use of a supra‐annular valve strategy for an early degenerated THV.