Surgical aortic valve replacement after percutaneous aortic valve implantation: What have we learned?

Pierre Yves Litzler, Alain Cribier, Alan Zajarias, Diane Comte, Hélène Eltchaninoff, Christophe Tron, Catherine Haas-Hubscher, Jean Paul Bessou

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

Objective: We report the first case description of surgical aortic valve replacement after percutaneous valve implantation. Methods: An 87-year-old man with severe aortic stenosis who was rejected for surgical intervention underwent percutaneous valve implantation through a retrograde femoral approach. The procedure was complicated by cardiogenic shock caused by severe aortic insufficiency, leading to emergency surgical aortic valve replacement. Results: The operative findings revealed the presence of commissural paravalvular leaks and centrally malapposed leaflets. Surgical replacement was uneventful, and the patient was discharged on day 30, despite a challenging postoperative course. His follow-up at 1 year has been uneventful. This case illustrates that overdilatation of the stent is not recommended because it might worsen central aortic insufficiency. Moreover, the transapical route should be considered when the appropriately sized prosthesis is unable to be inserted because of inappropriate vascular access. However, despite an initial "prohibitive" surgical risk, surgical aortic valvular replacement after percutaneous valve implantation could be easily performed. Conclusion: Percutaneous heart valve implantation, which provides a larger surface area than balloon valvotomy, can be offered to patients with cardiogenic shock and severe comorbidities to improve their hemodynamic state and reduce their surgical risk.

Original languageEnglish
Pages (from-to)697-701
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume136
Issue number3
DOIs
StatePublished - Sep 1 2008
Externally publishedYes

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